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| <table> | | <table> |
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| <tr><td>Active cancer (treatment within last 6 months or palliative) </td><td><input type="checkbox" name="input1" value="1.0" onchange="calcScore();" /></td></tr> | | <tr><td>Prior episode of VTE</td><td><input type="checkbox" name="input1" value="1.0" onchange="calcScore();" /></td></tr> |
| <tr><td>Calf swelling >3 cm compared to other calf (measured 10 cm below tibial tuberosity) </td><td><input type="checkbox" name="input2" value="1.0" onchange="calcScore();" /></td></tr> | | <tr><td>Thrombophilia</td><td><input type="checkbox" name="input2" value="1.0" onchange="calcScore();" /></td></tr> |
| <tr><td>Collateral superficial veins (non-varicose) </td><td><input type="checkbox" name="input3" value="1.0" onchange="calcScore();" /></td></tr> | | <tr><td>Paralysis of the lower extremity during the hospitalization</td><td><input type="checkbox" name="input3" value="1.0" onchange="calcScore();" /></td></tr> |
| <tr><td>Pitting edema (confined to symptomatic leg) </td><td><input type="checkbox" name="input4" value="1.0" onchange="calcScore();" /></td></tr> | | <tr><td>Current malignancy</td><td><input type="checkbox" name="input4" value="1.0" onchange="calcScore();" /></td></tr> |
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| <tr><td>Swelling of entire leg </td><td><input type="checkbox" name="input5" value="1.0" onchange="calcScore();" /></td></tr> | | <tr><td>Immobilization for at least 7 days</td><td><input type="checkbox" name="input5" value="1.0" onchange="calcScore();" /></td></tr> |
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| <tr><td>Localized pain along distribution of deep venous system </td><td><input type="checkbox" name="input6" value="1.0" onchange="calcScore();" /></td></tr> | | <tr><td>ICU or CCU admission</td><td><input type="checkbox" name="input6" value="1.0" onchange="calcScore();" /></td></tr> |
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| <tr><td>Paralysis, paresis, or recent cast immobilization of lower extremities </td><td><input type="checkbox" name="input7" value="1.0" onchange="calcScore();" /></td></tr> | | <tr><td>Age more than 60 years</td><td><input type="checkbox" name="input7" value="1.0" onchange="calcScore();" /></td></tr> |
| <tr><td>Recently bedridden > 3 days, or major surgery requiring regional or general anesthetic in past 12 weeks </td><td><input type="checkbox" name="input8" value="1.0" onchange="calcScore();" /></td></tr>
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| <tr><td>Previously documented DVT </td><td><input type="checkbox" name="input9" value="1.0" onchange="calcScore();" /></td></tr>
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| <tr><td>Alternative diagnosis at least as likely </td><td><input type="checkbox" name="input10" value="- 2.0" onchange="calcScore();" /></td></tr>
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| </table> | | </table> |