XOS Brace

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

  • Please do not print the Review page.

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

  • XOS BRACE

    Intake Information
  • Format: (000) 000-0000.
    • Patient Information: 
    • Bilateral:*
    • Bilateral Type:*
    • Affected Side:*
    • Weight Unit:
    • Scan being submitted with this order:

    • Submission Type:

      • Plaster Cast: Negative or Positive

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

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

    • Raven Base Code:
    • Device Type

  • XOS BRACE

    Configurator

  • Please order an XOS Kit. 

  • 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
    • Materials/Design: 
    • Cuff Style:*
    • Foot Plate:*
    • Plate Strength:*
    • Closure Type:*
    • Finish:*
    • Sole:*

    • Strut is provided with the kit.
      Complete this section only if the design deviates from kit.

    • PDE Spring Length:
    • PDE Spring Category:*

  • XOS BRACE

    Notes
  • Who would you like a call from?*
  • 0/250
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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}{requestedInoffice1217}{requestedInoffice1247}{requestedInoffice1248}

    • Requested In-Office Date: 
    • Image field 1256

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

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