Karnofsky Performance Scale

(Commonly used for assessing terminally ill patients)

Name: _____________________ Today's Date: _________

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