UniqueIdentifierSpineMarkerEmergencyProcedureProcedureSitePre-opVerificationDNRStatusSpecialWristbandLaterality(Side)PhysicianSignatureConsentFormSurgicalCountPatientNameSpecialEquipmentTime-outSignedConsentMedicalRecordDiagnosticTestsPre-ProcedureCheckTeamDebriefingVerbalIdentification2ndTimeOutRadiographicImagesSiteMarkingCorrectImplantUniqueIdentifierSpineMarkerEmergencyProcedureProcedureSitePre-opVerificationDNRStatusSpecialWristbandLaterality(Side)PhysicianSignatureConsentFormSurgicalCountPatientNameSpecialEquipmentTime-outSignedConsentMedicalRecordDiagnosticTestsPre-ProcedureCheckTeamDebriefingVerbalIdentification2ndTimeOutRadiographicImagesSiteMarkingCorrectImplant

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