PatientNameMedicalRecordSiteMarkingEmergencyProcedureRadiographicImagesSignedConsentProcedureSiteSurgicalCountSpecialEquipmentVerbalIdentificationUniqueIdentifierSpineMarkerSpecialWristbandDNRStatusConsentFormPhysicianSignatureDiagnosticTestsTeamDebriefingPre-ProcedureCheckCorrectImplantTime-outPre-opVerification2ndTimeOutLaterality(Side)PatientNameMedicalRecordSiteMarkingEmergencyProcedureRadiographicImagesSignedConsentProcedureSiteSurgicalCountSpecialEquipmentVerbalIdentificationUniqueIdentifierSpineMarkerSpecialWristbandDNRStatusConsentFormPhysicianSignatureDiagnosticTestsTeamDebriefingPre-ProcedureCheckCorrectImplantTime-outPre-opVerification2ndTimeOutLaterality(Side)

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