To diagnose ME/CFS, physicians should follow the following procedures to rule out ALL OTHER ORGANIC DISEASE:

1. Clinically evaluate cases of prolonged or chronic fatigue by:
   1. Physical examination and medical history

   2. Mental status examination (abnormalities require appropriate psychiatric, psychological, or neurological examination)

   3. Screening lab tests:
      • CBC
      • ESR
      • ALT
      • Total protein
      • Albumin
      • Globulin
      • Alkaline Phosphatase
      • CA
      • PO4
      • Glucose
      • BUN
      • Electrolytes
      • Creatin
      • TSH
      • UA

   4. Resolve any and all abnormal test results that strongly suggest an exclusionary condition

   5. Additional tests as clinically indicated to exclude other diseases

   6. Exclude case if another cause for chronic fatigue is found

2. Classify case as either ME/CFS or Idiopathic Chronic Fatigue if fatigue persists or relapses for longer than 6 months

3. Classify as Chronic Fatigue Syndrome if:
   1. Criteria for severity of fatigue are met, and

   2. Four or more of the following symptoms are concurrently present for longer than six months:
      • Impaired memory or concentration
      • Sore throat
      • Tender Cervical or Axillary lymph nodes
      • Muscle pain
      • Multi-joint pain without swelling or redness
      • New type or severity of headaches
      • Unrefreshing sleep
      • Post exertion malaise lasting more than 24 hours

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