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