RICHIE STYLE AFO

  • 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.

  • - Please create a new account to use the Save Draft feature - 

  • RICHIE STYLE AFO

    Intake Information

  • Please enter a correct Fab PCC#

    • Patient Information: 

    • Bilateral Symmetrical: 

      • Left and Right sides can have different Measurements
      • Same Alignment, Design and Finishing options

    • Upload Scan at the end. 

    • Submission Type:

      • Plaster Cast: Negative or Positive

        Please include a printed Work Order with the cast when shipping.

    • Your order will be sent to CDC after submission. 

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      • 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. 

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    • Daily HFN Capacity

    • {requestedInoffice1035}{requestedInoffice1280}{requestedInoffice1281}{requestedInoffice1282}{requestedInoffice1283}{requestedInoffice1284}{requestedInoffice1285}

    • Requested In-Office Date: 
    • Image field 1278

    • Clinicians can still coordinate special in-office requests by emailing:
      HFN_Hypercare@hanger.com

  • RICHIE STYLE AFO

    Device Type

  • Black Plastic. No Transfers available for this selection.

  • RICHIE STYLE AFO

    Configurator
  • 0/250
    • Measurements: 
    • Patient Measurements
    • Patient Measurements
    • Image field 347
    • Alignment: 

    • i

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

    • Final Ankle Position:

    • Set the Ankle in   *   ° of      *        

    • If "As Casted" Forefoot Alignment is required, please select "Other" and provided the as casted alignment. 

    • 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 field 1192
    • Image field 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 field 1140
    • Image field 1141
    • Image field 1142
    • Image field 1145
    • Image field 1143
    • Image field 1144

    • Plastic

    • Special Order Transfer Papers can increase device turnaround time.

    • PLEASE SELECT DIFFERENT OPTIONS FOR TRANSFER PAPERS.

    • Finishing: 
    • Image field 1124
    • Image field 1125
    • Image field 1123
    • Image field 1126
    • Image field 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)

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

    (No Entry required at the LEO portal)

    • 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. 

      

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