Pre-ProcedureCheckEmergencyProcedureConsentFormTime-outLaterality(Side)PatientNameTeamDebriefing2ndTimeOutVerbalIdentificationCorrectImplantPre-opVerificationSignedConsentProcedureSiteSpecialWristbandSiteMarkingMedicalRecordSpineMarkerSurgicalCountUniqueIdentifierDNRStatusPhysicianSignatureRadiographicImagesSpecialEquipmentDiagnosticTestsPre-ProcedureCheckEmergencyProcedureConsentFormTime-outLaterality(Side)PatientNameTeamDebriefing2ndTimeOutVerbalIdentificationCorrectImplantPre-opVerificationSignedConsentProcedureSiteSpecialWristbandSiteMarkingMedicalRecordSpineMarkerSurgicalCountUniqueIdentifierDNRStatusPhysicianSignatureRadiographicImagesSpecialEquipmentDiagnosticTests

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