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  • Agilik KAFO/HKAFO

    Intake Information
  • Format: (000) 000-0000.
    • Patient Information: 

    • There is a max weight limit of 160 kg/352 lbs. 

    • Medial Knee Joint (17K45) required for patients over 154 lbs (70 kg). 

    • Submission Type:

      • Plaster Cast: Negative or Positive

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

    • The Shipping section is now at the end of the form.

  • Agilik KAFO/HKAFO

    Configurator
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    • Casting 

    • TWO STAGE CAST IS REQUIRED

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    • ALIGNMENT CASTING BLOCK:

    • Medial Knee Joint (17K45) required for this Knee Extension angle.

    • Toe Ramp Angle:

      • Low < 10° – household ambulators with limited community ambulation
      • Moderate 12-15° – community ambulator
      • High 15-30° – active community ambulators
    • Measurements 
    • Image field 1196
    • Image field 1225

    • If a candidate's knee center to trochanter length is less than 25 cm, the device cannot be fabricated. This is due to the actuator attachment points length exceeding the available segment length.

    • If a candidate's knee center to trochanter length is less than 10 in, the device cannot be fabricated. This is due to the actuator attachment points length exceeding the available segment length.

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    • Rows
    • Rows
    • Rows
    • Rows
    • 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      *        

    • Final Knee Position (Sagittal Plane):

    • Set the Knee in   *   ° of      *        

    • Final Knee Position (Coronal Plane):

    • Set the Knee in   *   ° of      *        

    • Modifications: 

    • Standard Mods include:

      • 3mm (1/8") buildup at the Malleoli, Navicular and Base of the 5th. 
      • 3mm (1/8") reduction at the Medial Longitudinal Arch Apex. 
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    • Materials/Design: 

    • Posting:

    • {intrinsicHeel990} Intrinsic Heel Skive was selected. 

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    • Joints:

    • Image field 1326

    • Ankle Joints:

  • Agilik KAFO/HKAFO

    Notes
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  • Daily HFN Capacity

  • {requestedInoffice}{requestedInoffice1354}{requestedInoffice1355}

    • Requested In-Office Date: 
    • Image field 1358

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

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