SurgicalCountMedicalRecordRadiographicImagesPatientNameDiagnosticTestsSpecialWristbandSiteMarkingPre-opVerificationEmergencyProcedureConsentFormPre-ProcedureCheckTime-outCorrectImplantVerbalIdentificationLaterality(Side)UniqueIdentifierProcedureSiteSpineMarkerPhysicianSignatureTeamDebriefingSpecialEquipment2ndTimeOutDNRStatusSignedConsentSurgicalCountMedicalRecordRadiographicImagesPatientNameDiagnosticTestsSpecialWristbandSiteMarkingPre-opVerificationEmergencyProcedureConsentFormPre-ProcedureCheckTime-outCorrectImplantVerbalIdentificationLaterality(Side)UniqueIdentifierProcedureSiteSpineMarkerPhysicianSignatureTeamDebriefingSpecialEquipment2ndTimeOutDNRStatusSignedConsent

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