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Ready-made questionnaire templates you can insert into your own questionnaire.

Charlson Comorbidity Index — FHIR Questionnaire Template

Comorbidities and age with the age-adjusted Charlson Comorbidity Index.

Scoring

Comorbidities score 1, 2, 3 or 6 points by weight; the age adds 1 point per decade from 50, up to 4 points from age 80. The index appears once the age is entered; an unanswered comorbidity counts as No.

Questions

  1. Myocardial infarction
  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. Hemiplegia or paraplegia
  10. Renal disease
  11. Leukemia
  12. Lymphoma
  13. AIDS
  14. Liver disease
    • None
    • Mild
    • Moderate or severe
  15. Diabetes
    • None
    • Without end-organ damage
    • With end-organ damage
  16. Solid tumor
    • None
    • Localized
    • Metastatic
  17. Age (years)

Calculated results

Source and license

Source: Charlson et al. 1987, J Chronic Dis 40:373; age adjustment per Charlson et al. 1994, J Clin Epidemiol 47:1245. (link)

License: Original wording written for this builder; covered by the project license (non-commercial use with attribution; commercial use needs written permission). Formulas are published methods; see the source. (link)

Provided to save authoring effort, not as medical advice — confirm the scale and its cut-offs for your use case.

Use it

  1. Download the FHIR Questionnaire JSON, or
  2. open the Builder, choose + Add → From template…, search for “Charlson Comorbidity Index” and insert it. It arrives as one titled group with its calculations wired, and you can keep editing it.

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