3D PRINTED AFO

  • Legacy form will be accepted until Sep 1st. Access Legacy PDF work orders below:

    3D Printed Solid, Semi-Solid, PLS & Articulated AFO MCS 3D AFO

  • Please do not print the Review page.

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

  • 3D PRINTED AFO

    Intake Information
  • Format: (000) 000-0000.
    • Patient Information: 
    • Bilateral:*
    • Bilateral Type:*
    • Affected Side:*

    • Bilateral Symmetrical: 

      • Left and Right sides can have different Measurements
      • Same Alignment, Design and Finishing options
    • Weight Unit:
    • Activity Level:*
    • Weight Profile:

    • Max weight level is 275 lbs. 

    • Submission Type:*
    • Scanner Type:*

    • Upload Scan at the end. 

    • Hanger 3D app:*

    • Your order will be sent to CDC after submission. 

    • Date:*
       - -
    • Is this a Hanger3D app scan?*
      • 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. NO OTHER ACTION IS NEEDED

        

    • Scan Type:*

    • 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. 

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

  • 3D PRINTED AFO

    Device Type
  • Raven Base Code:
  • Device Type

  • Tuning Principles can be applied to this device. 

  • 3D PRINTED AFO - {deviceType1068}
    Configurator

  • 0/250
    • Tuning: 
    • Tuning: Is this device being tuned?

    • Casting block Height and Toe Ramp Angle measurements are recommended.
      If Heel Wedging alone is required, please proceed to the Materials/Design section.

    • Foot on Casting block
    • Please indicate measurement unit:*
    • Tuning Ankle Alignment:*

    • Final Ankle Position (Ankle Angle):

    • Set the Ankle in   *   ° of      *       

    • Set Heel Wedge To:*
    • Image field 874
    • External Heel Wedge Attachment:*
    • Measurements: 
    • Go by:*
    • Please indicate measurement unit:*
    • Patient Measurements
    • Patient Measurements

    • Selected unit: {pleaseIndicate910}

    • Max Height Level is 343 mm. 

    • Max Height Level is 406 mm. 

    • Max Height Level is 13.5 inches. 

    • Max Height Level is 16 inches. 

    • Alignment: 

    • i

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

    • Ankle Alignment:*

    • Final Ankle Position:

    • Set the Ankle in   *   ° of      *        

    • Heel Height Accommodation:*
    • Forefoot Alignment:*

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

    • Final Forefoot Position:

    • Set the Forefoot in   *   ° of      *        

    • Hindfoot Alignment:*

    • Final Hindfoot Position:

    • Set the Hindfoot in   *   ° of      *        

    • Modifications/Trimlines: 
    • Tone Reducing Modifications:
    • Image field 1274
    • Image field 1275
    • Buildups/Reductions:

    • 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. 
    • Met Heads:
    • Medial Malleolus:
    • Lateral Malleolus:
    • Navicular:
    • Base of the 5th:
    • Posterior Heel (pump bump):
    • Medial Longitudinal Arch Apex Reduction:
    • Image field 1047
    • Image field 1048
    • Foot Mod Add ons:
    • Intrinsic Heel Skive:*
    • Skive Magnitude:*

    • Intrinsic Heel Skive requires external posting/wedging.

    • i

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

    • Trimline Profile:*
    • Image field 1185
    • Image field 1186
      • Standard: 1/8" deflection from the leg with extra accommodation at the malleoli to reduce edge pressure.
      • Gutter: Material added to create a "gutter" shape so the trimlines are inline with the apex of the buildups. (Commonly used for Positioning or Night time Stretching AFOs).
    • Trimline Profile Default
    • Trimline Profile:
    • Trimline Profile Location Default
    • Gutter Trimline Profile Location:*
    • Image field 1189
    • Image field 1190
    • Image field 1191
    • Midfoot Trimline Default:
    • Image field 1106
    • Midfoot Trimline:
    • Plastic Footplate Trimline Default:
    • MCS Plastic Footplate Trimline Default:
    • Footplate Trimline:
    • Forefoot Trimline Default:
    • Forefoot Trimline:
    • Image field 1049
    • Image field 1064
    • Additional Options:
    • Image field 1050
    • Right - Additional Options:
    • Left Supramalleolar Extension:*
    • Right - Supramalleolar Extension:*
    • Materials/Design: 

    • Posting:

    • External Heel Wedge:
    • Image field 1118

    • Posting options will not be available if a Heel Wedge is selected.

    • {intrinsicHeel990} Intrinsic Heel Skive was selected.

    • Heel Post:
    • Heel Post Degrees:*
    • Heel Post Material:*
    • Image field 1119
    • Image field 1120
    • Image field 1121
    • External Forefoot Post:
    • External Forefoot Post Material:*
    • Image field 1122
    • Image field 1123
    • Image field 1138

    • Strut Selection:

    • Composite Strut Options:*
    • Composite Strut Options:*
    • PDE Neuro Spring Length:*
    • PDE Neuro Firmness (Soft to Firm):*
    • Trulife Neuro Firmness (Soft to Firm):*
    • Image field 1258
    • Coyote Firmness (Extra Soft to Extra Rigid):*

    • Ankle Joints

    • Joints:*
    • Tamarack w/Dorsiflexion Assist:*

    • Plastic

    • i

      Click Here: Best Practice for Grinding, Finishing & Heating 3D Printed PA12

    • Plastic Type:*
    • Image field 1266
    • Image field 1267
    • Plastic Thickness:*
    • Anterior Shell (Optional):
    • Anterior Shell Plastic Thickness:*
    • Reinforcement:
    • Inner Boot:
    • Inner Boot Thickness:*
    • Inner Boot Thickness:*
    • Image field 1082
    • Padding: 
    • Full Device Padding Thickness:*
    • Anterior Shell Padding Thickness:*
    • Supramalleolar Ext. Padding Thickness:*
    • Plantar Surface Padding Thickness:*
    • Malleoli Padding:
    • Malleoli Padding Thickness:*
    • Calf Padding Thickness:*
    • Navicular Padding Thickness:*
    • Padding Insertion:
    • Finishing: 

    • Copper fasteners are not available for 3D printed AFOs. 

    • Fastener Type:*
    • Strap Type:*
    • Leather Strap Color:*
    • Dacron Strap Color:*
    • Velcro Strap Color:*
    • Calf Strap Width:*
    • Calf Strap Placement:*
    • Proximal Ankle Strap Width:
    • Proximal Ankle Strap Placement:*

    • Instep strap options are in development for 3D Printed AFOs and not currently available.

    • Instep Strap Width:
    • Instep Strap Placement:*
    • Instep Strap Style:*
    • Image field 1065
    • Image field 1069
    • Image field 1142
    • Add-Ons:
    • Non-Skid Surface:*

  • 3D PRINTED AFO - {deviceType1068}
    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. NO OTHER ACTION IS NEEDED

      

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  • Patient Gender:*

  • Non-standard designs (custom trimlines, aesthetic additions, etc.) cannot be accommodated with this order form. If a device with these changes is needed, please reach out directly to 3DPrinting@Hanger.com

  • Who would you like a call from?*
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  • Return Shipping Method:
  • Shipping is same as Billing Address:*
  • Requested In-Office Date:
     - -
  • Requested In-Office Date:
     - -
  • Requested In-Office Date:
     - -
  • Requested In-Office Date:
     - -

  • Daily HFN Capacity

  • {requestedInoffice}{requestedInoffice1351}{requestedInoffice1352}{requestedInoffice1353}

    • Requested In-Office Date: 
    • Image field 1356

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

    • Today's Date:*
       - -
  • Should be Empty: