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