ECO/LEATHER AFO GAUNTLETS/MBB Logo

  • Please do not print the Review page.

    Scroll to the bottom, hit Complete and then download the work order. 

  • Access Legacy PDF work order. Legacy form will be accepted until Aug 15th. 

  • Legacy form will no longer be accepted. 

  • ECO/LEATHER AFO GAUNTLETS/MBB

    Intake Information
  •  - -

  • Daily HFN Capacity

  •  - -

  • ECO/LEATHER AFO GAUNTLETS/MBB

    Patient Information

  • Orlando is temporarily not available to take Digital orders. We expect them to be back up by the end of week. 

  • The Scan Upload is available at the end of the Form.

    • Please complete this form. Next, after acquiring the scan via the Hanger3D app, go to Order Forms > Jotform Order and fill out the required information and submit the scan. 

      

  • The Cast Measurement fields are available at the end of the Form.

  • Due to the scan being modified, the Alignment and Modification options will not be displayed.

    Any Alignment or Modification changes can be called out in the Notes section. 

  • ECO/LEATHER AFO GAUNTLETS/MBB

    Device Type

  • ECO/LEATHER AFO GAUNTLETS/MBB

    Configurator
  • 0/250
    • Measurements: 
    • Image-347
    • Image-965
    • Image-966
    • Alignment: 

    • i

      NEUTRAL is the Tibia perpendicular to the floor based on Heel Height. 

    • Final Ankle Position:

    • Set the Ankle in   *   ° of      *        

    • Final Forefoot Position:

    • Set the Forefoot in   *   ° of      *        

    • Final Hindfoot Position:

    • Set the Hindfoot in   *   ° of      *        

    • Modifications/Trimlines: 

    • Standard Mods include:

      • 3/16" (5 mm) buildup at the Malleoli
      • 1/8" (3 mm) build up at the Navicular, Base of the 5th and Met heads.  
    • Image-1028
    • Image-954

    • Intrinsic Heel Skive requires external posting.

    • Provided Finished Foot Plate Length: {finishedFootplate}{finishedFootplate926}

    • Trimlines

    • Image-978
    • Materials/Design: 

    • Posting:

    • Image-979
    • Image-980
    • Image-981

    • Ankle Joints

    • i

      Finished Plastic Thickness will be within 10% of the requested thickness. 

    • Image-958
    • Image-959
    • Image-960
    • Image-961
    • Image-962

    • Padded Collar required for EcoTex. 

    • Finishing: 
    • Image-956
    • Image-957

    • Adjustable Reel available with Leather only. 

  • ECO/LEATHER AFO GAUNTLETS/MBB

    Notes

  • Your order will be sent to CDC after submission along with the Scan. No futher action is needed.

    (No Entry required at the LEO portal)

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