DNRStatusCorrectImplantRadiographicImagesSpineMarkerUniqueIdentifierSiteMarkingEmergencyProcedureMedicalRecordSurgicalCountPatientNameSpecialWristbandProcedureSiteDiagnosticTestsSpecialEquipmentPre-opVerificationLaterality(Side)2ndTimeOutVerbalIdentificationTime-outTeamDebriefingSignedConsentConsentFormPhysicianSignaturePre-ProcedureCheckDNRStatusCorrectImplantRadiographicImagesSpineMarkerUniqueIdentifierSiteMarkingEmergencyProcedureMedicalRecordSurgicalCountPatientNameSpecialWristbandProcedureSiteDiagnosticTestsSpecialEquipmentPre-opVerificationLaterality(Side)2ndTimeOutVerbalIdentificationTime-outTeamDebriefingSignedConsentConsentFormPhysicianSignaturePre-ProcedureCheck

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