Use this tool to rate your condition as often as you need to. Share your ratings with your healthcare provider to evaluate your progress and response to treatments.

	Illness Severity Rating Sheet
Rating	Description
0	No symptoms. Able to sustain a normal level of activity.
10	Occasional mild symptoms. Able to sustain a normal level of activity.
20	More frequent mild symptoms. Able to sustain a near- normal level of activity.
30	Some moderate symptoms. Able to work full-time with difficulty.
40	Mild to moderate symptoms. Able to work up to 7 hours per day.
50	Mostly moderate symptoms. Able to work up to 5 hours per day. Daily rests required.
60	Moderate symptoms. Able to do up to 4 hours of sedentary activity daily. Can leave home. Daily rests required.
70	Moderate to severe symptoms. Able to do up to 2 hours of sedentary activity daily. Can leave home up to 3 times per week. Daily rests required.
80	Mostly severe symptoms. Able to do up to 1 hour of sedentary activity daily. Can leave home up to 2 times per week. Daily rests required.
90	Severe symptoms. Bedridden most of the time.
100	Completely bedridden. Unable to care for self.
	Adapted from the Patient’s Guide To Chronic Fatigue Syndrome and Fibromyalgia by Bruce Campbell, 2006