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