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