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