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Geriatric Assessment Tool
Karnofsky Performance Scale
Client Name
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Assessment Date
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________________________________________ |
_______________ |
100 Normal, no complaints, no evidence of disease
90 Able to carry on normal activity: minor symptoms of disease
80 Normal activity with effort: some symptoms of disease
70 Cares for self: unable to carry on normal activity or active work
60 Requires occasional assistance but is able to care for needs
50 Requires considerable assistance and frequent medical care
40 Disabled: requires special care and assistance
30 Severely disabled: hospitalization is indicated, death not imminent
20 Very sick, hospitalization necessary: active treatment necessary
10 Moribund, fatal processes progressing rapidly
0 Death
Assessed By
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Signature
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References
Commonly used for assessing terminally ill patients. Click here for Wikipedia Performance Status article.
1. Karnofsky DA, Burchenal JH. (1949). "The Clinical Evaluation of Chemotherapeutic Agents in Cancer." In: MacLeod CM (Ed), Evaluation of Chemotherapeutic Agents. Columbia Univ Press. Page 196. |
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350 Greenhaven Terrace,
Tonawanda, NY 14150 W 716-213-4345
F 888-387-1238 E-mail drstall@stallgeriatrics.com
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Last update 7/29/10
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