PLASTIC AFO w/COMPOSITE STRUT

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

  • Legacy form will no longer be accepted.

  • - Please create a new account to use the Save Draft feature - 

  • Please do not print the Review page.

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

  • PLASTIC AFO w/COMPOSITE STRUT

    Intake Information

  • HFN Rocky Hill (Cromwell) has relocated! Our new address is:
    31 Inwood Rd, Rocky Hill, CT 06067

  • Please enter a correct Fab PCC#

    • Patient Information: 

    • Bilateral Symmetrical: 

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

    • Submission Type:

      • Plaster Cast: Negative or Positive

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

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

      • 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. 

        

    • 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. 

    •  - -
    •  - -
    •  - -
    •  - -

    • Daily HFN Capacity

    • {requestedInoffice}{requestedInoffice1408}{requestedInoffice1409}{requestedInoffice1410}

    • Requested In-Office Date: 
    • Image-1413

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

  • PLASTIC AFO w/COMPOSITE STRUT

    Device Type

  • PLASTIC AFO w/COMPOSITE STRUT

    Configurator
  • 0/250

  • GUIDANCE

    • Any brace with a flat toe plate will require shoe work to function
    • Any brace without a contoured foot plate/toe ramp is prone to fail

    • Measurements: 
    • Patient Measurements
    • Patient Measurements
    • Patient Measurements
    • Alignment: 

    • i

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

    • Final Ankle Position:

    • Set the Ankle in   *   ° of      *        

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

    • Final Forefoot Position:

    • Set the Forefoot in   *   ° of      *        

    • Set the foot in   *   ° of      * Rotation.

    • Final Hindfoot Position:

    • Set the Hindfoot in   *   ° of      *        

    • Modifications/Trimlines: 

    • Standard Mods include:

      • 1/8" (3 mm) buildup at the Malleoli, Navicular and Base of the 5th. 
      • 1/8" (3 mm) reduction at the Medial Longitudinal Arch Apex. 
    • Image-1047
    • Image-1048

    • Intrinsic Heel Skive requires external posting/wedging.

    • Image-1386
    • Image-1387
      • 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).
    • Image-1391
    • Image-1392
    • Image-1393
    • Image-1106
    • Image-1049
    • Image-1064
    • Image-1050
    • Materials/Design: 
    • Image-1241
    • Image-1242

    • Posting/Wedging:

    • Posting:

    • Image-1118

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

    • {intrinsicHeel990} Intrinsic Heel Skive was selected.

    • Image-1119
    • Image-1120
    • Image-1121
    • Image-1122
    • Image-1123
    • Image-1138

    • Plastic

    • i

      Finished Plastic Thickness will be within 10% of the requested thickness. 

    • Special Order Transfer Papers can increase device turnaround time.

    • PLEASE SELECT DIFFERENT OPTIONS FOR TRANSFER PAPERS.

    • Image-1082
    • Padding: 

    • Additional Padding

    • Finishing: 
    • Image-1065
    • Image-1069
    • Image-1142

  • PLASTIC AFO w/COMPOSITE STRUT

    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)

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • 0/250
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  •  - -
  • Should be Empty: