TEMPLATE ACRIBIS Follow-up (ACRIBIS Follow-up)

TEMPLATE ID	ACRIBIS Follow-up
Concept	ACRIBIS Follow-up
Description	Not Specified
Purpose	Not Specified
References
Authors	date: 2026-06-30; name: Rony Ventura; organisation: Universitätsklinikum Schleswig-Holstein; email: rony.ventura@uksh.de
Other Details Language	date: 2026-06-30; name: Rony Ventura; organisation: Universitätsklinikum Schleswig-Holstein; email: rony.ventura@uksh.de
Other Details (Language Independent)	Sem Ver: 12.0.0 MD5-CAM-1.0.1: 086cb4fc082b366cd35ddad4fe39d241 PARENT:MD5-CAM-1.0.1: A60D0B7F52F1F9C3C9B3518DB83ACDAE Original Language: ISO_639-1::en
Language used	en
Citeable Identifier	1246.169.4072
Root archetype id	openEHR-EHR-COMPOSITION.report.v1
ACRIBIS Follow-up	ACRIBIS Follow-up: Document to communicate information to others, commonly in response to a request from another party.
Other Context
Report ID	Report ID: Identification information about the report.
Case identification	Case identification: To record case identification details for public health purposes.
Case identifier	Case identifier: The identifier of this case.
ACRIBIS Follow-up	ACRIBIS Follow-up: ACRIBIS_Follow_up
Data
Any event	Any event: @ internal @
Data
Who is completing the quesstionnaire?	Who is completing the quesstionnaire?: * 1: Patient 2: Relative 3: Doctor 4: Other person
Who is it? (name)	Who is it? (name): *
ACRIBIS Follow-up death	ACRIBIS 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 period	ACRIBIS 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
When was the heart attack diagnosed	When was the heart attack diagnosed: *
Was a stroke or cerebrovascular disease diagnosed?	Was a stroke or cerebrovascular disease diagnosed?: * 1: Yes 2: No 3: Unknown
When was the stroke/ cerebrovascular disease diagnosed?	When was the stroke/ cerebrovascular disease diagnosed?: *
Do you know which type of stroke was diagnosed?	Do you know which type of stroke was diagnosed?: * 1: Stroke due to vessel occlusion 2: Brain hemorrhage (intracerebral or subarchnoid) 3: No
ACRIBIS Follow-up severe bleeding	ACRIBIS 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
When did this/these severe bleeding event(s) last occur?	When did this/these severe bleeding event(s) last occur?: *
ACRIBIS Follow-up TIA	ACRIBIS 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 failure	ACRIBIS 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?: *
Was the participant treated in hospital in the past year due to a worsening of their heart failure?	Was the participant treated in hospital in the past year due to a worsening of their heart failure?: * 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
Which further cardiovascular disease(s) are involved?	Which further cardiovascular disease(s) are involved?: *
When was this disease diagnosed?	When was this disease diagnosed?: *
How was the follow-up collected?	How was the follow-up collected?: * 1: Email 2: By mail 3: By phone 4: Unknown
EQ-5D-5L Health status	EQ-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 event	Any event: *
Data
Mobility	Mobility: Issues with mobility. 1: No problems 2: Slight problems 3: Moderate problems 4: Severe problems 5: Unable to walk about.
Self-care	Self-care: Issues with self-care. 1: No problems 2: Slight problems 3: Moderate problems 4: Severe problems 5: Unable to wash or dress
Usual activities	Usual 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/discomfort	Pain/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/depression	Anxiety/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
State	State: A 5-digit code formed from the scores of each component, with 9 indicating a missing value e.g. '21491'
Overall health	Overall health: A self-assessment of overall health on a scale from 0 to 100 0..100
PROMIS	PROMIS: 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 event	Any 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 name	Assessment or test name: The name of the PROMIS assessment or test performed. For example: 'PROMIS-29' or 'PROMIS-57'.
Total score	Total score: The total score of the PROMIS assessment.
Protocol
PROMIS Bank v2.0 - Physical Function	PROMIS 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 - Anxiety	PROMIS Item Bank v1.0 - Anxiety: The PROMIS item bank v1.0 for anxiety.
In the past 7 days: I felt fearful	In 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 anxiety	In 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 me	In 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 uneasy	In 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 Bank v1.0 - Depression	PROMIS Bank v1.0 - Depression: The PROMIS item bank v1.0 for depression.
In the past 7 days: I felt worthless	In 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 helpless	In 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 depressed	In 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 hopeless	In 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 - Fatigue	PROMIS Item Bank v1.0 - Fatigue: The PROMIS item bank v1.0 for fatigue.
During the past 7 days: I feel fatigued	During 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 tired	During 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 Disturbance	PROMIS Item Bank v1.0 - Sleep Disturbance: The PROMIS item bank v1.0 for sleep disturbance.
In the past 7 days: My sleep quality was	In 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 refreshing	In 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 sleep	In 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 asleep	In 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 Activities	PROMIS 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 others	I 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 do	I 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 do	I 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 Interference	PROMIS 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 Health	PROMIS Scale v1.2 - Global Health: The PROMIS scale v1.2 for global health.
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

TEMPLATE ACRIBIS Follow-up (ACRIBIS Follow-up)

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