Time-outCorrectImplantLaterality(Side)SpecialEquipmentPre-opVerificationTeamDebriefingConsentFormSpecialWristbandPatientNamePhysicianSignatureVerbalIdentification2ndTimeOutEmergencyProcedureMedicalRecordSurgicalCountUniqueIdentifierDiagnosticTestsRadiographicImagesSignedConsentPre-ProcedureCheckSpineMarkerSiteMarkingDNRStatusProcedureSiteTime-outCorrectImplantLaterality(Side)SpecialEquipmentPre-opVerificationTeamDebriefingConsentFormSpecialWristbandPatientNamePhysicianSignatureVerbalIdentification2ndTimeOutEmergencyProcedureMedicalRecordSurgicalCountUniqueIdentifierDiagnosticTestsRadiographicImagesSignedConsentPre-ProcedureCheckSpineMarkerSiteMarkingDNRStatusProcedureSite

Informed Consent Policy - 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. Time-out
  2. Correct Implant
  3. Laterality (Side)
  4. Special Equipment
  5. Pre-op Verification
  6. Team Debriefing
  7. Consent Form
  8. Special Wristband
  9. Patient Name
  10. Physician Signature
  11. Verbal Identification
  12. 2nd Time Out
  13. Emergency Procedure
  14. Medical Record
  15. Surgical Count
  16. Unique Identifier
  17. Diagnostic Tests
  18. Radiographic Images
  19. Signed Consent
  20. Pre-Procedure Check
  21. Spine Marker
  22. Site Marking
  23. DNR Status
  24. Procedure Site