CUSTOM TRANSFEMORAL AMPUSHIELD

  • 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 Sep 1st. 

  • CUSTOM TRANSFEMORAL 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
    •  - -
    •  - -
    •  - -
    •  - -
    •  - -
    •  - -

    • Daily HFN Capacity

    • {estimatedShip1514}{requestedInoffice1588}{requestedInoffice1589}{requestedInoffice1590}

    • Requested In-Office Date: 
    • Image field 1593

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

  • CUSTOM TRANSFEMORAL AMPUSHIELD

    Intake Information
  • 0/250
    • Measurements: 
    • Image field 1362
    • Image field 1363
    • Design: 
    • Image field 1529

    • 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
  • 0/250
  • Should be Empty: