Pharmacoepi CML-Score
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ENTER BASELINE VALUES ONLY!

Patient Initials:               Sex:
Date of birth:                
Age 1-100 (years):       Spleen size* (0 - 50) cm:   
Blasts 0 - 100 (%) :      Eosinophils (0 - 100) %:  
Basophils 0 - 100 (%) :  Platelets (0 - 3000) 109/l: 
* spleen size palpated, in cm below costal margin

(Red fields are optional)

Pharmacoepidemiology Research Group.
Copyright © 1999.
13. Juni 2002