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.

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