Spine Marker Correct Implant Consent Form Consent Form Pre-op Verification Team Debriefing Laterality (Side) Patient Name Medical Record Patient Name Pre- Procedure Check Signed Consent Emergency Procedure Site Marking Unique Identifier Time- out Special Wristband Pre- Procedure Check Medical Record Correct Implant Diagnostic Tests Radiographic Images Procedure Site Verbal Identification Verbal Identification Special Equipment Radiographic Images Time- out Signed Consent Physician Signature Unique Identifier Pre-op Verification 2nd Time Out DNR Status FREE SPACE Physician Signature Spine Marker Special Wristband Site Marking Diagnostic Tests Team Debriefing Surgical Count Emergency Procedure DNR Status Team Concurrence Surgical Count Laterality (Side) Procedure Site Special Equipment Spine Marker Correct Implant Consent Form Consent Form Pre-op Verification Team Debriefing Laterality (Side) Patient Name Medical Record Patient Name Pre- Procedure Check Signed Consent Emergency Procedure Site Marking Unique Identifier Time- out Special Wristband Pre- Procedure Check Medical Record Correct Implant Diagnostic Tests Radiographic Images Procedure Site Verbal Identification Verbal Identification Special Equipment Radiographic Images Time- out Signed Consent Physician Signature Unique Identifier Pre-op Verification 2nd Time Out DNR Status FREE SPACE Physician Signature Spine Marker Special Wristband Site Marking Diagnostic Tests Team Debriefing Surgical Count Emergency Procedure DNR Status Team Concurrence Surgical Count Laterality (Side) Procedure Site Special Equipment
(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.
Spine Marker
Correct Implant
Consent Form
Consent Form
Pre-op Verification
Team Debriefing
Laterality (Side)
Patient Name
Medical Record
Patient Name
Pre-Procedure Check
Signed Consent
Emergency Procedure
Site Marking
Unique Identifier
Time-out
Special Wristband
Pre-Procedure Check
Medical Record
Correct Implant
Diagnostic Tests
Radiographic Images
Procedure Site
Verbal Identification
Verbal Identification
Special Equipment
Radiographic Images
Time-out
Signed Consent
Physician Signature
Unique Identifier
Pre-op Verification
2nd Time Out
DNR Status
FREE SPACE
Physician Signature
Spine Marker
Special Wristband
Site Marking
Diagnostic Tests
Team Debriefing
Surgical Count
Emergency Procedure
DNR Status
Team Concurrence
Surgical Count
Laterality (Side)
Procedure Site
Special Equipment