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  • Please do not print the Review page.

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

  • Access Legacy PDF work order. Legacy form will be accepted until Sep 1st. 

  • CUSTOM TRANSTIBIAL AMPUSHIELD

    Intake Information

  • Daily HFN Capacity

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  • CUSTOM TRANSTIBIAL AMPUSHIELD

    Patient Information

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

    • Please complete and submit the form and print out the Work Order PDF. In the Hanger 3D app, go to Order Forms > Take a Picture and upload the printed PDF along with your scan.

      

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

  • CUSTOM TRANSTIBIAL AMPUSHIELD

    Intake Information
    • Measurements: 
    • Image-1362
    • Image-1363
      • Flexion angles greater than 20 degrees require a Rigid PE Protector with step locks. Device will be designed neutral and can be adjusted at fitting.
    • Design: 
    • Image-1519
    • Image-1520
    • Image-1521
    • Image-1529

    • IMPORTANT: Proximal Trim length from MPT must be a minimum of 8" (20 cm) for
      Semi-Rigid frame. 

    • i

      Ventilation is an option for an Unlined Rigid Protector. 

    • i

      Fabrication will adjust distal length to accommodate for end pad. 

    • Ships with additional 1" adjustment pad. 

  • CUSTOM TRANSTIBIAL AMPUSHIELD

    Notes

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

    (No Entry required at the Sharepoint portal)

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