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