CUSTOM TRANSTIBIAL AMPUSHIELD

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

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

  • CUSTOM TRANSTIBIAL AMPUSHIELD

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

    • Bilateral Symmetrical: 

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

    • {requestedInoffice}{requestedInoffice1570}{requestedInoffice1571}{requestedInoffice1572}

    • Requested In-Office Date: 
    • Image field 1577

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

  • CUSTOM TRANSTIBIAL AMPUSHIELD

    Intake Information
  • 0/250
    • Measurements: 
    • Image field 1362
    • Image field 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 field 1519
    • Image field 1520
    • Image field 1521
    • Image field 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
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  • Should be Empty: