ISP Review - 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. Authorized Units of Service & Frequency
2. Current Living Arrangmnt
3. Name Parent(s) or Guardian
4. Unit Cost
5. Care Level
6. Service Name
7. Start/End Dates
8. Service Provider Contact Info
9. Service Code Number
10. Initial ISP Dvlpmnt Date
11. Parental Payment
12. Outcome Number
13. Daily Cost
14. Medicaid Cost Share
15. Participant Signature
16. Current ISP Completion Date
17. Participant Informed Rights & Choice
18. Plan Type
19. Plan Review/ Update Verific.
20. Total Waiver Cost/Day
21. Functional Screen Date
22. Date Signed
23. Funding Source
24. Outlier Rate