PhysicianSignatureSpecialEquipmentSpecialWristbandRadiographicImagesTeamDebriefingSpineMarkerMedicalRecordPatientNamePre-ProcedureCheckVerbalIdentification2ndTimeOutPre-opVerificationDiagnosticTestsConsentFormSignedConsentSiteMarkingTime-outLaterality(Side)UniqueIdentifierEmergencyProcedureSurgicalCountDNRStatusCorrectImplantProcedureSitePhysicianSignatureSpecialEquipmentSpecialWristbandRadiographicImagesTeamDebriefingSpineMarkerMedicalRecordPatientNamePre-ProcedureCheckVerbalIdentification2ndTimeOutPre-opVerificationDiagnosticTestsConsentFormSignedConsentSiteMarkingTime-outLaterality(Side)UniqueIdentifierEmergencyProcedureSurgicalCountDNRStatusCorrectImplantProcedureSite

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