RICHIE STYLE AFO 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.

  • RICHIE STYLE AFO

    Intake Information

  • Please enter a correct Fab PCC#

  •  - -

  • Daily HFN Capacity

  •  - -

  • RICHIE STYLE AFO

    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. 

  • RICHIE STYLE AFO

    Device Type

  • RICHIE STYLE AFO

    Configurator
  • 0/250
    • Measurements: 
    • Patient Measurements
    • Patient Measurements
    • Image-347
    • 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:

      • 1/8" (3 mm) buildup at the Malleoli
    • Image-1192
    • Image-1114

    • Intrinsic Heel Skive requires external posting.

    • i

      Standard Default: 1/8" deflection at Malleoli away from the leg to reduce edge pressure

    • Provided Finished Plastic Foot Plate Length: {finishedFootplate1000}{finishedFootplate}

    • Provided Finished Top Cover Length: {finishedTop}{finishedTop1078}

    • Materials/Design: 

    • Ankle Joints:

    • Posting:

    • Image-1140
    • Image-1141
    • Image-1142
    • Image-1145
    • Image-1143
    • Image-1144

    • Plastic

    • Special Order Transfer Papers can increase device turnaround time.

    • PLEASE SELECT DIFFERENT OPTIONS FOR TRANSFER PAPERS.

    • Finishing: 
    • Image-1124
    • Image-1125
    • Image-1123
    • Image-1126
    • Image-1149

  • RICHIE STYLE AFO

    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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