Charlson Comorbidity Index Score: 0 / 29 = 0.0 %

Instructions: Please complete the below questions.

1. Myocardial infarction (history of)

2. Congestive heart failure

3. Peripheral vascular disease

4. Cerebrovascular disease

5. Dementia

6. Chronic pulmonary disease

7. Rheumatologic disease

8. Peptic ulcer disease

9. Liver disease

10. Diabetes

11. Hemiplegia or paraplegia

12. Renal disease

13. Malignancy

14. AIDS/HIV