TRANSFEMORAL DIAGNOSTIC SOCKET Logo

  • 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. 

  • Legacy form will no longer be accepted.

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

  • TRANSFEMORAL DIAGNOSTIC SOCKET

    Intake Information
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  • Daily HFN Capacity

  • TRANSFEMORAL DIAGNOSTIC SOCKET

    Patient Information
    • Patient Information: 

    • 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 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. 

  • TRANSFEMORAL DIAGNOSTIC SOCKET

    Intake Information
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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. 

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  • TRANSFEMORAL 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 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.

      

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