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