TRANSFEMORAL/KNEE DISARTIC DIAGNOSTIC SOCKET

  • 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. 

  • TRANSFEMORAL/KNEE DISARTIC DIAGNOSTIC SOCKET

    Intake Information

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

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

    • Bilateral Symmetrical: 

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

    • Upload Scan at the end.

    • Submission Type:

      • Diagnostic Socket
      • Plaster Cast: Negative or Positive

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

    • Your order will be sent to CDC after submission. 

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      • 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. NO OTHER ACTION IS NEEDED

        

    • The Cast Measurement fields are available at the end of the Form. 

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

  • TRANSFEMORAL/KNEE DISARTIC DIAGNOSTIC SOCKET

    Configurator
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    • Measurements: 
      • Always scan/cast & measure over the liner you are fitting with.
      • Length measurements must be taken from the Perineum. 
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    • Design: 

    • Brim Style Descriptions

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    • Alignment (Optional): 

    • Fabrication: 
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    • Lock not provided. If needed, Please write in the Lock request in the Notes need.

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  • TRANSFEMORAL/KNEE DISARTIC DIAGNOSTIC SOCKET

    Notes

  • Your order will be sent to CDC after submission. No futher action is needed.

    (No Entry required at the Sharepoint portal)

    • 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. NO OTHER ACTION IS NEEDED

      

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  • Daily HFN Capacity

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

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