TEMPLATE ACRIBIS Follow-up (ACRIBIS Follow-up)

TEMPLATE IDACRIBIS Follow-up
ConceptACRIBIS Follow-up
DescriptionNot Specified
PurposeNot Specified
References
Authorsdate: 2026-06-30; name: Rony Ventura; organisation: Universitätsklinikum Schleswig-Holstein; email: rony.ventura@uksh.de
Other Details Languagedate: 2026-06-30; name: Rony Ventura; organisation: Universitätsklinikum Schleswig-Holstein; email: rony.ventura@uksh.de
Other Details (Language Independent)
  • Sem Ver: 22.0.0
  • MD5-CAM-1.0.1: 0af51b1a9b6d1c0e53a88a1a369c3470
  • PARENT:MD5-CAM-1.0.1: A60D0B7F52F1F9C3C9B3518DB83ACDAE
  • Original Language: ISO_639-1::de
Language useden
Citeable Identifier1246.169.4072
Root archetype idopenEHR-EHR-COMPOSITION.report.v1
ACRIBIS Follow-upACRIBIS Follow-up: Document to communicate information to others, commonly in response to a request from another party.
Other Context
Report IDReport ID: Identification information about the report.
Case identificationCase identification: To record case identification details for public health purposes.
Case identifierCase identifier: The identifier of this case.
ACRIBIS Follow-upACRIBIS Follow-up: ACRIBIS_Follow_up
Data
Any eventAny event: @ internal @
Data
Who is completing the questionnaire?Who is completing the questionnaire?: *
  • 1: Patient 
  • 2: Relative 
  • 3: Doctor 
  • 4: Other person 
How was the follow-up collected?How was the follow-up collected?: *
  • 1: Email 
  • 2: By mail 
  • 3: By phone 
  • 4: Unknown 
ACRIBIS Follow-up deathACRIBIS Follow-up death: acribis_follow_up_death
Has the patient died?Has the patient died?: *
  • 1: Yes 
  • 2: No 
  • 3: Unknown 
When did the patient die?When did the patient die?: *
Was a cardiovascular disease determined to be the cause of death?Was a cardiovascular disease determined to be the cause of death?: *
  • 1: Yes 
  • 2: No 
  • 3: Unknown 
Which of the cardiovascular causes of death listed in the answer option applied?Which of the cardiovascular causes of death listed in the answer option applied?: *
  • 1: Heart attack 
  • 2: Stroke due to vessel occlusion 
  • 3: Brain hemorrhage (intracerebral or subarachnoid) 
  • 4: Other cardiovascular cause 
  • 5: Unknown 
ACRIBIS Follow-up time periodACRIBIS Follow-up time period: acribis_follow_up_time period
Was a heart attack diagnosed?Was a heart attack diagnosed?: *
  • 1: Yes 
  • 2: No 
  • 3: Unknown 
Wann wurde der Herzinfarkt diagnostiziert?Wann wurde der Herzinfarkt diagnostiziert?: *
Wurde ein Schlaganfall oder eine Erkrankung der Hirngefäße diagnostiziert?Wurde ein Schlaganfall oder eine Erkrankung der Hirngefäße diagnostiziert?: *
  • 1: Yes 
  • 2: No 
  • 3: Unknown 
When was the stroke/ cerebrovascular disease diagnosed?When was the stroke/ cerebrovascular disease diagnosed?: *
Wissen Sie, welche Art des Schlaganfalls diagnostiziert wurde?Wissen Sie, welche Art des Schlaganfalls diagnostiziert wurde?: *
  • 1: Stroke due to vessel occlusion 
  • 2: Brain hemorrhage (intracerebral or subarchnoid) 
  • 3: No 
ACRIBIS Follow-up severe bleedingACRIBIS Follow-up severe bleeding: acribis_follow_up_severe bleeding
Did a severe spontaneous bleeding event occur that was diagnosed and required medical treatment?Did a severe spontaneous bleeding event occur that was diagnosed and required medical treatment?: *
  • 1: Yes 
  • 2: No 
  • 3: Unknown 
Wann trat(en) diese starke(n) Blutung(en) letztmalig auf?Wann trat(en) diese starke(n) Blutung(en) letztmalig auf?: *
ACRIBIS Follow-up TIAACRIBIS Follow-up TIA: ACRIBIS_Follow_up_TIA
Was a transient ischemic attack diagnosed?Was a transient ischemic attack diagnosed?: *
  • 1: Yes 
  • 2: No 
  • 3: Unknown 
When was the transient ischemic attack last diagnosed?When was the transient ischemic attack last diagnosed?: *
Was atrial fibrillation (permanent or paroxysmal) diagnosed?Was atrial fibrillation (permanent or paroxysmal) diagnosed?: *
  • 1: Yes 
  • 2: No 
  • 3: Unknown 
When was atrial fibrillation diagnosed?When was atrial fibrillation diagnosed?: *
ACRIBIS Follow-up heart failureACRIBIS Follow-up heart failure: ACRIBIS_Follow_up_heart_failure
Was heart failure (cardiac insufficiency) diagnosed?Was heart failure (cardiac insufficiency) diagnosed?: *
  • 1: Yes 
  • 2: No 
  • 3: Unknown 
When was heart failure diagnosed?When was heart failure diagnosed?: *
Wurden der Proband/die Probandin aufgrund einer Verschlechterung seiner/ihrer Herzinsuffizienz im letzten Jahr im Krankenhaus behandelt?Wurden der Proband/die Probandin aufgrund einer Verschlechterung seiner/ihrer Herzinsuffizienz im letzten Jahr im Krankenhaus behandelt?: *
  • 1: Yes 
  • 2: No 
  • 3: Unknown 
How often was a hospital stay necessary for this reason in the past year?How often was a hospital stay necessary for this reason in the past year?: *
When was the last hospital admission due to a worsening of heart failure?When was the last hospital admission due to a worsening of heart failure?: *
Was another cardiovascular disease diagnosed?Was another cardiovascular disease diagnosed?: *
  • 1: Yes 
  • 2: No 
  • 3: Unknown 
Um welche weitere Herz-Kreislauf-Erkrankung handelt es sich?Um welche weitere Herz-Kreislauf-Erkrankung handelt es sich?: *
When was this disease diagnosed?When was this disease diagnosed?: *
EQ-5D-5L Health statusEQ-5D-5L Health status: A standardised measure of health status to provide a simple, generic measure of health for clinical and economic appraisal.
Data
Any eventAny event: *
Data
MobilityMobility: Issues with mobility.
  • 1: No problems 
  • 2: Slight problems 
  • 3: Moderate problems 
  • 4: Severe problems 
  • 5: Unable to walk about. 
Self-careSelf-care: Issues with self-care.
  • 1: No problems 
  • 2: Slight problems 
  • 3: Moderate problems 
  • 4: Severe problems 
  • 5: Unable to wash or dress 
Usual activitiesUsual activities: Issues with usual activities.
e.g. work, study, housework, family or leisure activities.
  • 1: No problems 
  • 2: Slight problems 
  • 3: Moderate problems 
  • 4: Severe problems 
  • 5: Unable to do my usual activities 
Pain/discomfortPain/discomfort: Issues of pain or discomfort.
  • 1: No pain or discomfort 
  • 2: Slight pain or discomfort 
  • 3: Moderate pain or discomfort 
  • 4: Severe pain or discomfort 
  • 5: Extreme pain or discomfort 
Anxiety/depressionAnxiety/depression: Issue with anxiety or depression.
  • 1: No anxiety or depression 
  • 2: Slight anxiety or depression 
  • 3: Moderate anxiety or depression 
  • 4: Severe anxiety or depression 
  • 5: Extreme anxiety or depression 
StateState: A 5-digit code formed from the scores of each component, with 9 indicating a missing value
e.g. '21491'
Overall healthOverall health: A self-assessment of overall health on a scale from 0 to 100
0..100
PROMIS-29PROMIS-29: Patient Reported Outcomes Measurement Information System®, a set of over 300 measures of physical, mental, and social health for use with the general population and with individuals living with chronic conditions.
Data
Any eventAny event: Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time.
Data
Assessment or test nameAssessment or test name: The name of the PROMIS assessment or test performed.
For example: 'PROMIS-29' or 'PROMIS-57'.
  • PROMIS-29
Default value: PROMIS-29
PROMIS Item Bank v2.0 - Physical FunctionPROMIS Item Bank v2.0 - Physical Function: The PROMIS item bank v2.0 for physical function.
Are you able to do chores such as vacuuming or yard work?Are you able to do chores such as vacuuming or yard work?: Are you able to do chores such as vacuuming or yard work?
Optional[{item_code=PFA11}]
  • 5: Without any difficulty 
  • 4: With a little difficulty 
  • 3: With some difficulty 
  • 2: With much difficulty 
  • 1: Unable to do 

Annotations

  • Item Code: PFA11
Are you able to go up and down stairs at a normal pace?Are you able to go up and down stairs at a normal pace?: *
Optional[{item_code=PFA21}]
  • 5: Without any difficulty 
  • 4: With a little difficulty 
  • 3: With some difficulty 
  • 2: With much difficulty 
  • 1: Unable to do 

Annotations

  • Item Code: PFA21
Are you able to go for a walk of at least 15 minutes?Are you able to go for a walk of at least 15 minutes?: Are you able to go for a walk of at least 15 minutes?
Optional[{item_code=PFA23}]
  • 5: Without any difficulty 
  • 4: With a little difficulty 
  • 3: With some difficulty 
  • 2: With much difficulty 
  • 1: Unable to do 

Annotations

  • Item Code: PFA23
Are you able to run errands and shop?Are you able to run errands and shop?: *
Optional[{item_code=PFA53}]
  • 5: Without any difficulty 
  • 4: With a little difficulty 
  • 3: With some difficulty 
  • 2: With much difficulty 
  • 1: Unable to do 

Annotations

  • Item Code: PFA53
PROMIS Item Bank v1.0 - AnxietyPROMIS Item Bank v1.0 - Anxiety: The PROMIS item bank v1.0 for anxiety.
In the past 7 days: I felt fearfulIn the past 7 days: I felt fearful: I felt fearful.
Optional[{item_code=EDANX01}]
  • 1: Never 
  • 2: Rarely 
  • 3: Sometimes 
  • 4: Often 
  • 5: Always 

Annotations

  • Item Code: EDANX01
In the past 7 days: I found it hard to focus on anything other than my anxietyIn the past 7 days: I found it hard to focus on anything other than my anxiety: I found it hard to focus on anything other than my anxiety.
Optional[{item_code=EDANX40}]
  • 1: Never 
  • 2: Rarely 
  • 3: Sometimes 
  • 4: Often 
  • 5: Always 

Annotations

  • Item Code: EDANX40
In the past 7 days: My worries overwhelmed meIn the past 7 days: My worries overwhelmed me: My worries overwhelmed me.
Optional[{item_code=EDANX41}]
  • 1: Never 
  • 2: Rarely 
  • 3: Sometimes 
  • 4: Often 
  • 5: Always 

Annotations

  • Item Code: EDANX41
In the past 7 days: I felt uneasyIn the past 7 days: I felt uneasy: I felt uneasy.
Optional[{item_code=EDANX53}]
  • 1: Never 
  • 2: Rarely 
  • 3: Sometimes 
  • 4: Often 
  • 5: Always 

Annotations

  • Item Code: EDANX53
PROMIS Item Bank v1.0 - DepressionPROMIS Item Bank v1.0 - Depression: The PROMIS item bank v1.0 for depression.
In the past 7 days: I felt worthlessIn the past 7 days: I felt worthless: I felt worthless.
Optional[{item_code=EDDEP04}]
  • 1: Never 
  • 2: Rarely 
  • 3: Sometimes 
  • 4: Often 
  • 5: Always 

Annotations

  • Item Code: EDDEP04
In the past 7 days: I felt helplessIn the past 7 days: I felt helpless: I felt helpless.
Optional[{item_code=EDDEP06}]
  • 1: Never 
  • 2: Rarely 
  • 3: Sometimes 
  • 4: Often 
  • 5: Always 

Annotations

  • Item Code: EDDEP06
In the past 7 days: I felt depressedIn the past 7 days: I felt depressed: I felt depressed.
Optional[{item_code=EDDEP29}]
  • 1: Never 
  • 2: Rarely 
  • 3: Sometimes 
  • 4: Often 
  • 5: Always 

Annotations

  • Item Code: EDDEP29
In the past 7 days: I felt hopelessIn the past 7 days: I felt hopeless: I felt hopeless.
Optional[{item_code=EDDEP41}]
  • 1: Never 
  • 2: Rarely 
  • 3: Sometimes 
  • 4: Often 
  • 5: Always 

Annotations

  • Item Code: EDDEP41
PROMIS Item Bank v1.0 - FatiguePROMIS Item Bank v1.0 - Fatigue: The PROMIS item bank v1.0 for fatigue.
During the past 7 days: I feel fatiguedDuring the past 7 days: I feel fatigued: I feel fatigued.
Optional[{item_code=HI7}]
  • 1: Not at all 
  • 2: A little bit 
  • 3: Somewhat 
  • 4: Quite a bit 
  • 5: Very much 

Annotations

  • Item Code: HI7
During the past 7 days: I have trouble starting things because I am tiredDuring the past 7 days: I have trouble starting things because I am tired: I have trouble starting things because I am tired.
Optional[{item_code=AN3}]
  • 1: Not at all 
  • 2: A little bit 
  • 3: Somewhat 
  • 4: Quite a bit 
  • 5: Very much 

Annotations

  • Item Code: AN3
In the past 7 days: How run-down did you feel on average?In the past 7 days: How run-down did you feel on average?: How run-down did you feel on average?
Optional[{item_code=FATEXP41}]
  • 1: Not at all 
  • 2: A little bit 
  • 3: Somewhat 
  • 4: Quite a bit 
  • 5: Very much 

Annotations

  • Item Code: FATEXP41
In the past 7 days: How fatigued were you on average?In the past 7 days: How fatigued were you on average?: How fatigued were you on average?
Optional[{item_code=FATEXP40}]
  • 1: Not at all 
  • 2: A little bit 
  • 3: Somewhat 
  • 4: Quite a bit 
  • 5: Very much 

Annotations

  • Item Code: FATEXP40
PROMIS Item Bank v1.0 - Sleep DisturbancePROMIS Item Bank v1.0 - Sleep Disturbance: The PROMIS item bank v1.0 for sleep disturbance.
In the past 7 days: My sleep quality wasIn the past 7 days: My sleep quality was: My sleep quality was:
Optional[{item_code=Sleep109}]
  • 5: Very poor 
  • 4: Poor 
  • 3: Fair 
  • 2: Good 
  • 1: Very good 

Annotations

  • Item Code: Sleep109
In the past 7 days: My sleep was refreshingIn the past 7 days: My sleep was refreshing: My sleep was refreshing.
Optional[{item_code=Sleep116}]
  • 5: Not at all 
  • 4: A little bit 
  • 3: Somewhat 
  • 2: Quite a bit 
  • 1: Very much 

Annotations

  • Item Code: Sleep116
In the past 7 days: I had a problem with my sleepIn the past 7 days: I had a problem with my sleep: I had a problem with my sleep.
Optional[{item_code=Sleep20}]
  • 1: Not at all 
  • 2: A little bit 
  • 3: Somewhat 
  • 4: Quite a bit 
  • 5: Very much 

Annotations

  • Item Code: Sleep20
In the past 7 days: I had difficulty falling asleepIn the past 7 days: I had difficulty falling asleep: I had difficulty falling asleep.
Optional[{item_code=Sleep44}]
  • 1: Not at all 
  • 2: A little bit 
  • 3: Somewhat 
  • 4: Quite a bit 
  • 5: Very much 

Annotations

  • Item Code: Sleep44
PROMIS Item Bank v2.0 - Ability to Participate in Social Roles and ActivitiesPROMIS Item Bank v2.0 - Ability to Participate in Social Roles and Activities: The PROMIS item bank v2.0 for ability to participate in social roles and activities.
I have trouble doing all of my regular leisure activities with othersI have trouble doing all of my regular leisure activities with others: I have trouble doing all of my regular leisure activities with others.
Optional[{item_code=SRPPER11 _CaPS}]
  • 5: Never 
  • 4: Rarely 
  • 3: Sometimes 
  • 2: Often 
  • 1: Always 

Annotations

  • Item Code: SRPPER11 _CaPS
I have trouble doing all of the family activities that I want to doI have trouble doing all of the family activities that I want to do: I have trouble doing all of the family activities that I want to do.
Optional[{item_code=SRPPER18 _CaPS}]
  • 5: Never 
  • 4: Rarely 
  • 3: Sometimes 
  • 2: Often 
  • 1: Always 

Annotations

  • Item Code: SRPPER18 _CaPS
I have trouble doing all of my usual work (include work at home)I have trouble doing all of my usual work (include work at home): I have trouble doing all of my usual work (include work at home).
Optional[{item_code=SRPPER23 _CaPS}]
  • 5: Never 
  • 4: Rarely 
  • 3: Sometimes 
  • 2: Often 
  • 1: Always 

Annotations

  • Item Code: SRPPER23 _CaPS
I have trouble doing all of the activities with friends that I want to doI have trouble doing all of the activities with friends that I want to do: I have trouble doing all of the activities with friends that I want to do.
Optional[{item_code=SRPPER46 _CaPS}]
  • 5: Never 
  • 4: Rarely 
  • 3: Sometimes 
  • 2: Often 
  • 1: Always 

Annotations

  • Item Code: SRPPER46 _CaPS
PROMIS Item Bank v1.1 - Pain InterferencePROMIS Item Bank v1.1 - Pain Interference: The PROMIS item bank v1.1 for pain interference.
In the past 7 days: How much did pain interfere with your day to day activities?In the past 7 days: How much did pain interfere with your day to day activities?: How much did pain interfere with your day to day activities?
Optional[{item_code=PAININ9}]
  • 1: Not at all 
  • 2: A little bit 
  • 3: Somewhat 
  • 4: Quite a bit 
  • 5: Very much 

Annotations

  • Item Code: PAININ9
In the past 7 days: How much did pain interfere with work around the home?In the past 7 days: How much did pain interfere with work around the home?: How much did pain interfere with work around the home?
Optional[{item_code=PAININ22}]
  • 1: Not at all 
  • 2: A little bit 
  • 3: Somewhat 
  • 4: Quite a bit 
  • 5: Very much 

Annotations

  • Item Code: PAININ22
In the past 7 days: How much did pain interfere with your ability to participate in social activities?In the past 7 days: How much did pain interfere with your ability to participate in social activities?: How much did pain interfere with your ability to participate in social activities?
Optional[{item_code=PAININ31}]
  • 1: Not at all 
  • 2: A little bit 
  • 3: Somewhat 
  • 4: Quite a bit 
  • 5: Very much 

Annotations

  • Item Code: PAININ31
In the past 7 days: How much did pain interfere with your household chores?In the past 7 days: How much did pain interfere with your household chores?: How much did pain interfere with your household chores?
Optional[{item_code=PAININ34}]
  • 1: Not at all 
  • 2: A little bit 
  • 3: Somewhat 
  • 4: Quite a bit 
  • 5: Very much 

Annotations

  • Item Code: PAININ34
PROMIS Scale v1.2 - Global HealthPROMIS Scale v1.2 - Global Health: The PROMIS scale v1.2 for global health.
In general, how would you rate your health?In general, how would you rate your health?: In general, how would you rate your health?
Optional[{item_code=Global01}]
  • 1: Excellent 
  • 2: Very good 
  • 3: Good 
  • 4: Fair 
  • 5: Poor 

Annotations

  • Item Code: Global01
In general, how would you rate your quality of life?In general, how would you rate your quality of life?: In general, how would you rate your quality of life?
Optional[{item_code=Global02}]
  • 1: Excellent 
  • 2: Very good 
  • 3: Good 
  • 4: Fair 
  • 5: Poor 

Annotations

  • Item Code: Global02
In general, how would you rate your physical health?In general, how would you rate your physical health?: In general, how would you rate your physical health?
Optional[{item_code=Global03}]
  • 1: Excellent 
  • 2: Very good 
  • 3: Good 
  • 4: Fair 
  • 5: Poor 

Annotations

  • Item Code: Global03
In general, how would you rate your mental health, including your mood and your ability to think?In general, how would you rate your mental health, including your mood and your ability to think?: In general, how would you rate your mental health, including your mood and your ability to think?
Optional[{item_code=Global04}]
  • 1: Excellent 
  • 2: Very good 
  • 3: Good 
  • 4: Fair 
  • 5: Poor 

Annotations

  • Item Code: Global04
In general, how would you rate your satisfaction with your social activities and relationships?In general, how would you rate your satisfaction with your social activities and relationships?: In general, how would you rate your satisfaction with your social activities and relationships?
Optional[{item_code=Global05}]
  • 1: Excellent 
  • 2: Very good 
  • 3: Good 
  • 4: Fair 
  • 5: Poor 

Annotations

  • Item Code: Global05
In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.)In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.): In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.)
Optional[{item_code=Global09r}]
  • 1: Excellent 
  • 2: Very good 
  • 3: Good 
  • 4: Fair 
  • 5: Poor 

Annotations

  • Item Code: Global09r
To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?: To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?
Optional[{item_code=Global06}]
  • 1: Completely 
  • 2: Mostly 
  • 3: Moderately 
  • 4: A little 
  • 5: Not at all 

Annotations

  • Item Code: Global06
In the past 7 days: How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?In the past 7 days: How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?: How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?
Optional[{item_code=Global10r}]
  • 1: Never 
  • 2: Rarely 
  • 3: Sometimes 
  • 4: Often 
  • 5: Always 

Annotations

  • Item Code: Global10r
In the past 7 days: How would you rate your fatigue on average?In the past 7 days: How would you rate your fatigue on average?: How would you rate your fatigue on average?
Optional[{item_code=Global08r}]
  • 1: None 
  • 2: Mild 
  • 3: Moderate 
  • 4: Severe 
  • 5: Very severe 

Annotations

  • Item Code: Global08r
In the past 7 days: How would you rate your pain on average?In the past 7 days: How would you rate your pain on average?: How would you rate your pain on average?
Optional[{item_code=Global07r}]
  • 0: No pain 
  • 1: - 
  • 2: - 
  • 3: - 
  • 4: - 
  • 5: - 
  • 6: - 
  • 7: - 
  • 8: - 
  • 9: - 
  • 10: Worst pain imaginable 

Annotations

  • Item Code: Global07r
Total scoreTotal score: The total score of the PROMIS assessment.