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