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