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  • 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 Nov 1st. 

  • TRANSTIBIAL DIAGNOSTIC SOCKET

    Intake Information
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  • Daily HFN Capacity

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  • TRANSTIBIAL DIAGNOSTIC SOCKET

    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. 

  • TRANSTIBIAL DIAGNOSTIC SOCKET

    Intake Information
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    • Measurements: 
      • Always scan/cast & measure over the liner you are fitting with.
      • Measurements required at 1" (2.5 cm) intervals.
      • Anatomical landmarks of MPT, Fibular Head, & Distal Tibia must be located on the scan/cast.
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    • Design: 
    • Fabrication: 
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    • Lock not provided. 

    • Pin not provided. 

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  • TRANSTIBIAL DIAGNOSTIC SOCKET

    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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