DiagnosticTestsTeamDebriefingSignedConsentPre-opVerificationSpecialEquipmentCorrectImplantSpecialWristbandConsentFormPre-ProcedureCheckSpineMarkerEmergencyProcedureProcedureSiteDNRStatusLaterality(Side)VerbalIdentificationPhysicianSignatureSurgicalCountRadiographicImagesPatientNameMedicalRecord2ndTimeOutSiteMarkingUniqueIdentifierTime-outDiagnosticTestsTeamDebriefingSignedConsentPre-opVerificationSpecialEquipmentCorrectImplantSpecialWristbandConsentFormPre-ProcedureCheckSpineMarkerEmergencyProcedureProcedureSiteDNRStatusLaterality(Side)VerbalIdentificationPhysicianSignatureSurgicalCountRadiographicImagesPatientNameMedicalRecord2ndTimeOutSiteMarkingUniqueIdentifierTime-out

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.


1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
  1. Diagnostic Tests
  2. Team Debriefing
  3. Signed Consent
  4. Pre-op Verification
  5. Special Equipment
  6. Correct Implant
  7. Special Wristband
  8. Consent Form
  9. Pre-Procedure Check
  10. Spine Marker
  11. Emergency Procedure
  12. Procedure Site
  13. DNR Status
  14. Laterality (Side)
  15. Verbal Identification
  16. Physician Signature
  17. Surgical Count
  18. Radiographic Images
  19. Patient Name
  20. Medical Record
  21. 2nd Time Out
  22. Site Marking
  23. Unique Identifier
  24. Time-out