Patient'sGender_______AttendingPhysicianName________PatientStatus_______MedicalRecordNumber_________Units ofService_______PatientDischargeStatus________AdmissionDate_________PrincipalDiagnosisCode_________TotalCharges_______PatientControlNumber________OccurenceCodes________ConditionCodes________BillingProviderName_________Patient'sAddress_______ValueCodes_______Type ofBill_______ServiceDate_______StatementCoversPeriod__________PatientName_______RevenueCode________AdmissionType_________AdmissionSource_________Patient'sDOB_______HCPCS/Rates_______Patient'sGender_______AttendingPhysicianName________PatientStatus_______MedicalRecordNumber_________Units ofService_______PatientDischargeStatus________AdmissionDate_________PrincipalDiagnosisCode_________TotalCharges_______PatientControlNumber________OccurenceCodes________ConditionCodes________BillingProviderName_________Patient'sAddress_______ValueCodes_______Type ofBill_______ServiceDate_______StatementCoversPeriod__________PatientName_______RevenueCode________AdmissionType_________AdmissionSource_________Patient'sDOB_______HCPCS/Rates_______

UB-04 Bingo - 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's Gender _______
  2. Attending Physician Name ________
  3. Patient Status _______
  4. Medical Record Number _________
  5. Units of Service _______
  6. Patient Discharge Status ________
  7. Admission Date _________
  8. Principal Diagnosis Code _________
  9. Total Charges _______
  10. Patient Control Number ________
  11. Occurence Codes ________
  12. Condition Codes ________
  13. Billing Provider Name _________
  14. Patient's Address _______
  15. Value Codes _______
  16. Type of Bill _______
  17. Service Date _______
  18. Statement Covers Period __________
  19. Patient Name _______
  20. Revenue Code ________
  21. Admission Type _________
  22. Admission Source _________
  23. Patient's DOB _______
  24. HCPCS/ Rates _______