| Criteria | Score |
|---|---|
| Age (years) | |
| <65 | 1 |
| 65–75 | 2 |
| >75 | 3 |
| Diagnosis (code) | |
| Diabetes mellitus (250.X) | 2 |
| Chronic obstructive pulmonary disease (491.X, 492.X, 496.X) | 1 |
| Hypertension (401.X to 405.X inclusive) | 2 |
| Cardiovascular disease (410.X-414.X inclusive, 429.2, 434.0, 434.00, 434.01,435.8, 435.9, 436, 437.0, 437, 434.9x, 435, 437.1, 440.0, 441.3, 443, 440.8, 440.9, 441.4, 443.89, 443.9) | 2 |
| Heart failure (428.X) | 1 |
| Depression (311.x, 296.2x, 296.3x) | 1 |
| Estimated glomerular filtration rate <45 mL/min | 1 |
| Hemoglobin A1c | |
| >7.9% | 1 |
| >8.9% | 2 |
| BP | |
| Last BP >140/90 mmHg and last 3 averaged >140/90 mmHg | 1 |
| Last BP >160/100 mmHg and last 3 average >160/100 mmHg | 2 |
| Active items on medication list | |
| <3 | 0 |
| 3–5 | 1 |
| 6–9 | 2 |
| >9 | 4 |
BP, blood pressure.