Scoring Sheet for the Revised Canadian ME/CES Case Definition Scoring Sheet: To meet eri ria, a symptom must have a rating for Frequency and Severity of 2 or more, Ifa criterion is met, place a check next to the “Yes” question in the ‘scoring column, Dingnosis Categories Scoring Meets Criterion tig: Mast mea erierion for Questions 13,67, and SF-36 Seales Meets Fatigne Criteria Research Fatigue: Question 13, 13. Meets frequency and severity of 227 v MEICRS Mees Yes —~ | categorie 1 1 11, Lifelong problems with ftigue/eneray: Question 67. | 67, Indicates “No"? IV, V and Vt Mas answer No” ona that problem with Yes fatiguelenergy isnot ifelong, ‘Substantial Reduction: Meets eutof¥ ona east two SF-36 Scales, Role Physical (R: Score of <0 Vitality (Vp: Score oF 35, Sorial Functioning ($): Score of <62.8 Substantial Reduction: Meets 2 of 3 SF-36 scales? Yes 1, Post-Exertional Malaise: Atleast one symptom from Questions 14 to 18 Indicates frequency and severity of 22 on at least one symptom from questions 14 to 18? Yes, Malaise Criterion Yes UL Sleep: Atleast one symptom from Questions 19 to 24 Indicates frequency and severity of >2.on at least one symptom from questions 19 to 24 Yes Meets Sleep Criterion Yes 1, Pain At least one symptom from Questions 25 to 31 *To he counted for Question 31 (headaches) participant must answer “Yes” to Question 68 Indicates frequency and severity of 2 on at least one symptom from questions 28 to 31? Yes, Meets Pain Crit Yes V. Neurologial/Cognitive Manifestations: At Feast two symptoms from Questions 32 to 44 Indicates frequency and severity of 2 on at least ta sympionts from questions 32 €0 442 Yes Meets Neurological! Cognitive ‘Manifestations Citerion Yes VI Other Category Minimum of one symptom from two of the following three categories: 1, Autonomic Manifestations: Questions 45 to St b, Neuroendocrine Manifestations ‘Questions 52 t0 61 «Immune Manifestations: Questions 62 1066 a. Indicates frequency and severity of >2 on at least one symptom from questions 45 to SI? Yes Indicates frequency and severity of 2 on at least one symptom ffom questions 52 to 61? Yes, «Indicates Requeney and severity of 22 on at least one symptom fFom questions 62 to 66? Ye Meets Other Category Criteria Yes for $ of the 6 categories, Also, for VI oly one sympiom from one category is needed, Category Tis | require, Atypical MEICFS Meets criteria for 2 categories. MEICES- ike Meets eriteria or all categories but not fora duration of six or more months (see Question 69), __Remission Was diagnosed with ME/CFS at one time (See (Question 70) bat is currently experiencing 0-1 Criteria categories. ‘Complex Chronic Disease Program ME DePaul Symptom Questionnaire ~ Appendix B Page 1of2 Versio , May 23, 2013