Time-outMedicalRecord2ndTimeOutCorrectImplantDiagnosticTestsSiteMarkingPhysicianSignatureConsentFormSpineMarkerVerbalIdentificationLaterality(Side)UniqueIdentifierSpecialWristbandTeamDebriefingPatientNamePre-opVerificationSurgicalCountDNRStatusSpecialEquipmentProcedureSitePre-ProcedureCheckEmergencyProcedureRadiographicImagesSignedConsentTime-outMedicalRecord2ndTimeOutCorrectImplantDiagnosticTestsSiteMarkingPhysicianSignatureConsentFormSpineMarkerVerbalIdentificationLaterality(Side)UniqueIdentifierSpecialWristbandTeamDebriefingPatientNamePre-opVerificationSurgicalCountDNRStatusSpecialEquipmentProcedureSitePre-ProcedureCheckEmergencyProcedureRadiographicImagesSignedConsent

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