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APACHE II (Acute Physiology And Chronic Health Evaluation II) is a severity-of-disease classification system with a final score of 0 to 71, with higher scores corresponding to more severe disease and a higher risk of death. It is determined within 24 hours of admission to an intensive care unit (ICU).
Age:      Hematocrit:  
  WBC:    Rectal Temp  F-->C
MAP   MAP= [(2 x diastolic)+systolic] / 3
Heart Rate    Respiratory Rate
Serum Sodium(meq/L)   Serum K+(meq/L)
 (Oxygenation)
Arterial pH
Serum Creatinine (mg/dl):  
History of severe organ insufficiency (heart, liver, kidney, other) 
or immunocompromised?
 
Glasgow Coma Scoring:
Eye Opening:  Verbal:  
Motor:

Reference

Knaus WA Draper EA et al. APACHE II: A severity of disease classification 
system. Critical Care Medicine. 1985; 13 (Appendix pages 828-829) PubMed
APACHE II Severity-of-disease classification system