ElectronicSignatureWho isReceivingMissingMissingLetterof RepHIV/AIDSClauseMissingInformationto beDisclosedMissingRequestorAddressdoes notmatchRequestAuth isPoorQualityAuth inAnotherLanguagePurposeofDisclosureMissingSignatureDate inthe FuturePatientSignatureMissingSensitiveInformationMissingRe-DisclosureStatementMissingExpirationDate/EventMissingPoA orPersonalRepAuth DOESNOT allowSensitiveInfoWho isReleasingMissingPatientSignatureDateMissingAuthNeededbut notProvidedRequestedInfo differsfromAuthorizedInfoConditioningStatementMissingPatientDirectivePatientIdentifierMismatchRevocationStatementMissingElectronicSignatureWho isReceivingMissingMissingLetterof RepHIV/AIDSClauseMissingInformationto beDisclosedMissingRequestorAddressdoes notmatchRequestAuth isPoorQualityAuth inAnotherLanguagePurposeofDisclosureMissingSignatureDate inthe FuturePatientSignatureMissingSensitiveInformationMissingRe-DisclosureStatementMissingExpirationDate/EventMissingPoA orPersonalRepAuth DOESNOT allowSensitiveInfoWho isReleasingMissingPatientSignatureDateMissingAuthNeededbut notProvidedRequestedInfo differsfromAuthorizedInfoConditioningStatementMissingPatientDirectivePatientIdentifierMismatchRevocationStatementMissing

Authorization Bingo - Call List

(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.


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  1. Electronic Signature
  2. Who is Receiving Missing
  3. Missing Letter of Rep
  4. HIV/AIDS Clause Missing
  5. Information to be Disclosed Missing
  6. Requestor Address does not match Request
  7. Auth is Poor Quality
  8. Auth in Another Language
  9. Purpose of Disclosure Missing
  10. Signature Date in the Future
  11. Patient Signature Missing
  12. Sensitive Information Missing
  13. Re-Disclosure Statement Missing
  14. Expiration Date/Event Missing
  15. PoA or Personal Rep
  16. Auth DOES NOT allow Sensitive Info
  17. Who is Releasing Missing
  18. Patient Signature Date Missing
  19. Auth Needed but not Provided
  20. Requested Info differs from Authorized Info
  21. Conditioning Statement Missing
  22. Patient Directive
  23. Patient Identifier Mismatch
  24. Revocation Statement Missing