Date functional status evaluated:
Enter date of functional status testing. Date can either be entered directly in the data field using the DD/MMM/YYYY format, or the calendar date picker can be used.
Date should be within the specified visit window in the protocol. If the assessment date entered is outside of visit window a protocol deviation should be logged in the EDC.
If the date entered is a future date, a query will appear in the EDC.
Karnofsky Performance Scale:
Use this scale (see Table 1) to determine the score (10-100) that best represents the subject’s activity status at the requested time point.
Table 1. Karnofsky Scale
| Karnofsky Scale |
|---|
| 100% – Normal, no complaints, no evidence of disease |
| 90% – Able to carry on normal activity |
| 80% – Normal activity with effort |
| 70% – Cares for self, unable to carry on normal activity or to do active work |
| 60% – Requires occasional assistance but is able to care for most needs |
| 50% – Requires considerable assistance and frequent medical care |
| 40% – Disabled, requires special care and assistance |
| 30% – Severely disabled, hospitalization indicated, although death not imminent |
| 20% – Very sick, hospitalization necessary |
| 10% – Moribund, fatal process progressing rapidly |
CCG v1.0 | CRF v1.3
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