BURN AND PROTECTIVE MASKS

Legacy form will no longer be accepted.

Access Legacy PDF work order. Legacy form will be accepted until Mar 4th.

Please do not print the Review page.

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

Please enter a correct Fab PCC#

Please enter to receive confirmation.

Please enter a valid phone number.Format: (000) 000-0000.

Upload Scan at the end.

Your order will be sent to CDC after submission.

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

F8213 - Protective/Sport MaskF8212 - Burn Mask - SilonF8214 - Burn Mask - Durrplex

BURN MASKPROTECTIVE MASK

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Configurator

Decimal value optional

Photographs required for processing:(anterior, right, left); keep release form on file.

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

Silon is discontinued and no longer available.

3/32" (2 mm)1/8" (3 mm)3/16" (5 mm)1/4" (6 mm)

{deviceType1350}

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)

Modifications (Modifier)Design options on device (Fab Supervisor)Shipping/Billing (Customer Support)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Order ship date may be impacted by incomplete order, component availability and upon cast receipt (for physical orders).

{requestedInoffice}{requestedInoffice1236}{requestedInoffice1367}{requestedInoffice1368}

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

This option is for requests requiring a 24–48 hour turnaround. An expedite fee might apply.

Date

Hour MinutesAM/PM Option