• The purpose of this form is to code CD4 count and Karnofsky ratings for a client.

Operational Data Items

• Module 73A: ID Letters/ID Numbers, Site, Sub-Provider, Date, Staff Code, Client Gender, Karnofsky Rating, CD4 count and CD4 percent.

Citations

• Huba, G. J., Melchior, L. A., Staff of The Measurement Group, Cherin, D., and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1996). Module 73A: Karnofsky Rating Scale. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

Source Citation - KARNOFSKY PERFORMANCE STATUS SCALE (KPS): Karnofsky, D. A., Abelmann, W. H., Craver, L. F., and Burchenal (1948). The use of nitrogen mustards in the palliative treatment of cancer. Cancer, 1, 634-656.

Usage - Permission is granted for non-commercial use so long as form is not altered, the copyright is not removed, and a proper citation is made to the instrument. Non-commercial use is use by a not-for-profit organization in which the instrument is not sold. If you have questions about appropriate and proper uses, contact The Measurement Group.