MedicalDisclosurePanel boxinitialsFluoroscopyriskdatemissingreason forproceduremissingwitnesssignaturemissingPt AOx4but familysignedconsentbloodadministrationmissinginitialsAlzheimer'sin medicalhistory andpt signedconsentphysiciannameincompleteDementia inmedicalhistory andpt signedconsentPatientsignedconsent aftergivennarcoticsBronchoscopyrisktimemissingPEGrisk notinitialedAddendumnotwitnessedLungbiopsyriskpatientsignaturemissingUpper GIaddendummissingERCPrisk notinitialedLower GIaddendummissingbloodrecirculationmissinginitialsabbreviatedprocedureBloodAdministrationrisksBandingrisk notinitialedMedicalDisclosurePanel boxinitialsFluoroscopyriskdatemissingreason forproceduremissingwitnesssignaturemissingPt AOx4but familysignedconsentbloodadministrationmissinginitialsAlzheimer'sin medicalhistory andpt signedconsentphysiciannameincompleteDementia inmedicalhistory andpt signedconsentPatientsignedconsent aftergivennarcoticsBronchoscopyrisktimemissingPEGrisk notinitialedAddendumnotwitnessedLungbiopsyriskpatientsignaturemissingUpper GIaddendummissingERCPrisk notinitialedLower GIaddendummissingbloodrecirculationmissinginitialsabbreviatedprocedureBloodAdministrationrisksBandingrisk notinitialed

Consent BINGO - 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.


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  1. Medical Disclosure Panel box initials
  2. Fluoroscopy risk
  3. date missing
  4. reason for procedure missing
  5. witness signature missing
  6. Pt AOx4 but family signed consent
  7. blood administration missing initials
  8. Alzheimer's in medical history and pt signed consent
  9. physician name incomplete
  10. Dementia in medical history and pt signed consent
  11. Patient signed consent after given narcotics
  12. Bronchoscopy risk
  13. time missing
  14. PEG risk not initialed
  15. Addendum not witnessed
  16. Lung biopsy risk
  17. patient signature missing
  18. Upper GI addendum missing
  19. ERCP risk not initialed
  20. Lower GI addendum missing
  21. blood recirculation missing initials
  22. abbreviated procedure
  23. Blood Administration risks
  24. Banding risk not initialed