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