LEVEL 4 LEVEL 3 2 LEVEL 1 Areas of Functioning (4 points) (3 points) (2 points) (1 Describes the Client’s current physical and medical condition, prognosis and ability to meet his/her own basic life HEALTH STATUS and care needs. Client is completely Client needs assistance in Client assistance in Client is independent in all dependent on others for more than 3 areas of ADL; no more than 2 areas of areas of ADL and does not ACTIVITIES OF all medical care needs; AND/OR ADL; need assistance at any LIVING (ADL) AND/OR Client needs AND/OR time. ADL Client needs at least 12 assistance at least 4 hours Client assistance less hours of supervision a day. a day. than 4 hours a day. Score: Client has a CD4+ count Client has a CD4+ count Client has a CD4+ count Client has a CD4+ count HIV DISEASE less than 200 and/or viral between 200 and 350 between 350 and 500 more than 500 and/or is PROGRESSION load more than 400 and and/or viral load more and/or viral load more virally suppressed or has not on OI prophylaxis than 400 and not on ARV than 400; an undetectable viral load; medication; medication; OR OR OR OR Client has no history of an CD4+ count is more than Client has a current Client has a history of an opportunistic infection in 200 AND is virally opportunistic infection and opportunistic infection in the last 6 months and may suppressed or has an is not on treatment; the last 6 months, and or may not be on undetectable viral load; may/may not be on OI prophylaxis or OI OR OR Client has been prophylaxis or OI treatment; Client has no history of hospitalized in the last 30 treatment; OR opportunistic infection, days. OR Client has had no and may or may not be on OR Client has been hospitalizations in the past OI prophylaxis or ARV Client is diagnosed hospitalized within the last 12 months. medication; and client has six months. no history of Score: hospitalizations.
Areas of Functioning LEVEL 4 (4 points) LEVEL 3 (3 points) 2 (2 points) LEVEL 1 (1 HEALTH STATUS Describes the Client’s current physical and medical condition, prognosis and ability to meet his/her own basic life and care needs. ACTIVITIES OF LIVING (ADL) Score: Client is completely dependent on others for all medical care needs; AND/OR Client needs at least 12 hours of supervision a day. Client needs assistance in more than 3 areas of ADL; AND/OR Client needs ADL assistance at least 4 hours a day. Client assistance in no more than 2 areas of ADL; AND/OR Client assistance less than 4 hours a day. Client is independent in all areas of ADL and does not need assistance at any time. HIV DISEASE PROGRESSION Score: Client has a CD4+ count less than 200 and/or viral load more than 400 and not on OI prophylaxis medication; OR Client has a current opportunistic infection and is not on treatment; OR Client has been hospitalized in the last 30 days. OR Client is diagnosed Client has a CD4+ count between 200 and 350 and/or viral load more than 400 and not on ARV medication; OR Client has a history of an opportunistic infection in the last 6 months, and may/may not be on OI prophylaxis or OI treatment; OR Client has been hospitalized within the last six months. Client has a CD4+ count between 350 and 500 and/or viral load more than 400; OR Client has no history of an opportunistic infection in the last 6 months and may or may not be on prophylaxis or OI treatment; OR Client has had no hospitalizations in the past 12 months. Client has a CD4+ count more than 500 and/or is virally suppressed or has an undetectable viral load; OR CD4+ count is more than 200 AND is virally suppressed or has an undetectable viral load; OR Client has no history of opportunistic infection, and may or may not be on OI prophylaxis or ARV medication; and client has no history of hospitalizations.