# Cumulative Illness Rating Scale for Geriatrics (CIRS-G)

CIRS-G

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/cirs_g`
HTML: https://magentlab.com/docs/cirs-g
Markdown: https://magentlab.com/docs/cirs-g.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Sum fourteen caller-assigned Miller 1992 CIRS-G organ-system integers (each 0-4) and return the published total (max 56), the count of categories endorsed (rating ≥1), and the count of categories rated ≥3.

## When to use

When an agent already has Miller 1992 0-4 integers for the fourteen CIRS-G organ systems and needs the published total and ≥3 category count. magent does not examine the patient, diagnose comorbidity, score Charlson, or apply G8.

## When not to use

- Not a medical device and not a diagnosis or treatment order.
- Each of the fourteen organ-system ratings is a caller-assigned integer 0-4 (0 no problem, 1 current mild or past significant, 2 moderate disability or first-line therapy, 3 severe or uncontrollable chronic, 4 extremely severe, immediate treatment, or end-organ failure). magent does not examine the patient.
- This is Miller 1992 CIRS-G only (fourteen organ systems including psychiatric illness; max 56). It is not Charlson, not Linn 1968 CIRS, and not G8.
- Miller 1992 / the CIRS-G scoring sheet published total score, number of categories endorsed, and counts of categories at severity 3 and 4. This tool returns score, categories_endorsed, and categories_ge_3 (ratings 3 or 4). It does not invent a total-score class or a severity-index cutoff.

## Formula

```
CIRS-G = heart + vascular + hematopoietic + respiratory + eent + upper_gi + lower_gi + liver + renal + genitourinary + musculoskeletal + neurologic + endocrine_metabolic + psychiatric; each caller-assigned 0-4; max 56; Miller 1992; categories_endorsed is count of ratings ≥1; categories_ge_3 is count of ratings ≥3; no total-score class
```

## Citation

[Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale](https://doi.org/10.1016/0165-1781(92)90005-N)
Miller MD, Paradis CF, Houck PR, et al.
Psychiatry Res. 1992;41(3):237-248
DOI: [10.1016/0165-1781(92)90005-N](https://doi.org/10.1016/0165-1781(92)90005-N)

## Worked example

### All organ systems 0

Given: `eent=0, endocrine_metabolic=0, genitourinary=0, heart=0, hematopoietic=0, liver=0, lower_gi=0, musculoskeletal=0, neurologic=0, psychiatric=0, renal=0, respiratory=0, upper_gi=0, vascular=0`

1. heart, vascular, hematopoietic, respiratory, eent, upper_gi, lower_gi, liver, renal, genitourinary, musculoskeletal, neurologic, endocrine_metabolic, and psychiatric are 0 as assigned by the caller
2. Score = 0 (max 56); categories_endorsed = 0; categories_ge_3 = 0. Miller 1992 published no total-score class.


### Heart 3 and vascular 4

Given: `eent=0, endocrine_metabolic=0, genitourinary=0, heart=3, hematopoietic=0, liver=0, lower_gi=0, musculoskeletal=0, neurologic=0, psychiatric=0, renal=0, respiratory=0, upper_gi=0, vascular=4`

1. heart 3 + vascular 4; remaining twelve systems 0
2. Score = 7; categories_endorsed = 2; categories_ge_3 = 2 (both ratings ≥3). No total-score class.


## Also searched as

- CIRS-G
- CIRS(G)
- Cumulative Illness Rating Scale for Geriatrics
- Miller CIRS-G
- geriatric cumulative illness rating
- CIRS geriatric
- Miller 1992 CIRS
- organ-system comorbidity rating

## Parameters

- `heart` (integer, required): Caller-assigned Miller 1992 CIRS-G heart (integer 0-4: 0 no problem, 1 current mild or past significant, 2 moderate disability or first-line therapy, 3 severe or uncontrollable chronic, 4 extremely severe, immediate treatment, or end-organ failure). magent does not examine the patient.
- `vascular` (integer, required): Caller-assigned Miller 1992 CIRS-G vascular (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `hematopoietic` (integer, required): Caller-assigned Miller 1992 CIRS-G hematopoietic — blood, marrow, spleen, lymphatics (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `respiratory` (integer, required): Caller-assigned Miller 1992 CIRS-G respiratory — lungs, bronchi, trachea below the larynx (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `eent` (integer, required): Caller-assigned Miller 1992 CIRS-G EENT — eyes, ears, nose, throat, and larynx (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `upper_gi` (integer, required): Caller-assigned Miller 1992 CIRS-G upper GI — esophagus, stomach, duodenum (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `lower_gi` (integer, required): Caller-assigned Miller 1992 CIRS-G lower GI — intestines, hernias (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `liver` (integer, required): Caller-assigned Miller 1992 CIRS-G liver — including biliary and pancreatic trees (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `renal` (integer, required): Caller-assigned Miller 1992 CIRS-G renal — kidneys only (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `genitourinary` (integer, required): Caller-assigned Miller 1992 CIRS-G genitourinary — ureters, bladder, urethra, prostate, genitals, uterus, ovaries (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `musculoskeletal` (integer, required): Caller-assigned Miller 1992 CIRS-G musculoskeletal/integument — muscles, bone, and skin (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `neurologic` (integer, required): Caller-assigned Miller 1992 CIRS-G neurologic — brain, spinal cord, and nerves (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `endocrine_metabolic` (integer, required): Caller-assigned Miller 1992 CIRS-G endocrine/metabolic and breast (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.
- `psychiatric` (integer, required): Caller-assigned Miller 1992 CIRS-G psychiatric illness (integer 0-4: 0 no problem through 4 extremely severe). magent does not examine the patient.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/cirs_g`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "eent": "0",
      "endocrine_metabolic": "0",
      "genitourinary": "0",
      "heart": "0",
      "hematopoietic": "0",
      "liver": "0",
      "lower_gi": "0",
      "musculoskeletal": "0",
      "neurologic": "0",
      "psychiatric": "0",
      "renal": "0",
      "respiratory": "0",
      "upper_gi": "0",
      "vascular": "0"
    },
    {
      "eent": "0",
      "endocrine_metabolic": "0",
      "genitourinary": "0",
      "heart": "0",
      "hematopoietic": "0",
      "liver": "0",
      "lower_gi": "0",
      "musculoskeletal": "0",
      "neurologic": "0",
      "psychiatric": "0",
      "renal": "0",
      "respiratory": "0",
      "upper_gi": "0",
      "vascular": "0"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/cirs-g

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/cirs_g",
  "items": [
    {
      "components": [
        {
          "value": 0,
          "factor": "heart",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "vascular",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "hematopoietic",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "respiratory",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "eent",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "upper_gi",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "lower_gi",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "liver",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "renal",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "genitourinary",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "musculoskeletal",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "neurologic",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "endocrine_metabolic",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "psychiatric",
          "points": 0,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Miller MD, Paradis CF, Houck PR, et al.",
        "doi": "10.1016/0165-1781(92)90005-N",
        "id": "miller-1992",
        "pmid": "1594710",
        "source": "Psychiatry Res. 1992;41(3):237-248",
        "title": "Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale"
      },
      "formula": "cirs_g",
      "formula_expression": "CIRS-G = heart + vascular + hematopoietic + respiratory + eent + upper_gi + lower_gi + liver + renal + genitourinary + musculoskeletal + neurologic + endocrine_metabolic + psychiatric; each caller-assigned 0-4; max 56; Miller 1992; categories_endorsed is count of ratings ≥1; categories_ge_3 is count of ratings ≥3; no total-score class",
      "max_score": 56,
      "score": 0,
      "categories_endorsed": 0,
      "categories_ge_3": 0
    },
    {
      "components": [
        {
          "value": 0,
          "factor": "heart",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "vascular",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "hematopoietic",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "respiratory",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "eent",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "upper_gi",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "lower_gi",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "liver",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "renal",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "genitourinary",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "musculoskeletal",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "neurologic",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "endocrine_metabolic",
          "points": 0,
          "present": true
        },
        {
          "value": 0,
          "factor": "psychiatric",
          "points": 0,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Miller MD, Paradis CF, Houck PR, et al.",
        "doi": "10.1016/0165-1781(92)90005-N",
        "id": "miller-1992",
        "pmid": "1594710",
        "source": "Psychiatry Res. 1992;41(3):237-248",
        "title": "Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale"
      },
      "formula": "cirs_g",
      "formula_expression": "CIRS-G = heart + vascular + hematopoietic + respiratory + eent + upper_gi + lower_gi + liver + renal + genitourinary + musculoskeletal + neurologic + endocrine_metabolic + psychiatric; each caller-assigned 0-4; max 56; Miller 1992; categories_endorsed is count of ratings ≥1; categories_ge_3 is count of ratings ≥3; no total-score class",
      "max_score": 56,
      "score": 0,
      "categories_endorsed": 0,
      "categories_ge_3": 0
    }
  ]
}
```

## Response fields

- `formula` (string): cirs_g
- `formula_expression` (string): Exact expression used
- `score` (integer): Miller 1992 CIRS-G total: sum of fourteen caller-assigned 0-4 organ-system ratings (0-56)
- `max_score` (integer): Always 56
- `categories_endorsed` (integer): Count of the fourteen organ systems with caller-assigned rating ≥1 (Miller 1992 / CIRS-G scoring sheet: total number of categories endorsed). 0-14.
- `categories_ge_3` (integer): Count of organ systems with caller-assigned rating ≥3 (Miller 1992 / CIRS-G scoring sheet counts at severity 3 and at severity 4; this field is those counts combined). 0-14. Not a class.
- `components` (array): Per-system caller-assigned points
- `citation` (object): Miller et al. Psychiatry Res 1992 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "value": 0,
      "factor": "heart",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "vascular",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "hematopoietic",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "respiratory",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "eent",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "upper_gi",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "lower_gi",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "liver",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "renal",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "genitourinary",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "musculoskeletal",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "neurologic",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "endocrine_metabolic",
      "points": 0,
      "present": true
    },
    {
      "value": 0,
      "factor": "psychiatric",
      "points": 0,
      "present": true
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Miller MD, Paradis CF, Houck PR, et al.",
    "doi": "10.1016/0165-1781(92)90005-N",
    "id": "miller-1992",
    "pmid": "1594710",
    "source": "Psychiatry Res. 1992;41(3):237-248",
    "title": "Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale"
  },
  "formula": "cirs_g",
  "formula_expression": "CIRS-G = heart + vascular + hematopoietic + respiratory + eent + upper_gi + lower_gi + liver + renal + genitourinary + musculoskeletal + neurologic + endocrine_metabolic + psychiatric; each caller-assigned 0-4; max 56; Miller 1992; categories_endorsed is count of ratings ≥1; categories_ge_3 is count of ratings ≥3; no total-score class",
  "max_score": 56,
  "score": 0,
  "categories_endorsed": 0,
  "categories_ge_3": 0
}
```

## Errors

- HTTP 400 `invalid_cirs_g_item`: each CIRS-G organ-system rating must be an integer from 0 to 4 (Miller 1992). Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Charlson CCI](https://magentlab.com/docs/charlson) — Sum the nineteen Charlson 1987 original comorbidity weights and return the published 1-year mortality group.
- [G8](https://magentlab.com/docs/g8) — Sum the eight Bellera 2012 G8 items (seven MNA items A, B, C, E, F, H, P plus age) and return whether the published ≤14 impaired-screen cutoff is met.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.