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.

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