Instructions for use

Please Enter Information into following boxes and then click 'Submit' - results will be displayed in a table.
Please contact me with comments, if there is sufficient interest, I can add the ability to store results in a table/database.

Name/NHI (Optional)			Don't need to enter this, unless you want to print out result.
DOB		*	Not valid for assessment of persons <18 years or >80 years - Error Message if out of range.
Date First RRT	Not on Dialysis		Leave blank if not yet on dialysis on date of assessment.
Date Accepted	Not yet Accepted		Leave blank if not yet accepted (BUT ENTER ONE MONTH AFTER DIALYSIS START DATE IF ALREADY ON DIALYSIS AT 1 FEB 2013)
Date Referred			Date referred to transplant centre for consideration. For patients already on the list being reconsidered, enter date of reconsideration.
Albumin		* *	Use best available from three months prior to assessment
(Height in m)		*	height in m - enter height and weight to calculate BMI
(Weight in kg)		*	weight in kg - enter height and weight to calculate BMI
BMI		* *	kg/m2 - use estimated height if bilateral below knee amputee
Cause of ESRF	Diabetes Hypertension GN ADPKD Other		Choose from List
COPD	YesNoUnknown	*	YES if clinical diagnosis OR FEV1/FVC <70% without improvement on bronchodilator
Non-Ambulatory	YesNoUnknown	*	YES if unable to walk into clinic room on own (prostheses OK)
CHF	YesNoUnknown	*	YES if admission with heart failure (not fluid overload due to ESKD) OR latest echo (< 1year ago) LV EF <40%
On Insulin	YesNoUnknown	*	YES if currently prescribed or recommended insulin by treating physician/GP
CAD	YesNoUnknown	*	YES if prior MI, symptoms, positive stress test, coronary angio with >50% stenosis in any artery OR any prior intervention
PVD	YesNoUnknown	*	YES if symptoms, positive provocation test, >50% stenosis on angiography OR any prior intervention
CVD	YesNoUnknown	*	"YES" if history of stroke, TIA, carotid bruit OR revascularisation
HTN	YesNoUnknown	*	"YES" if current or prior treatment with antihypertensives
Smoker	YesNoUnknown	*	"NO" if ex smoker > 3 months OR never smoker
Employed	YesNoUnknown	*	"YES" if in part time or full time paid or unpaid work (including homemaker)
Ethnicity	NZ European European Maori Pacific Island Asian Other