TRANSHUMERAL DIAGNOSTIC SOCKET

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

  • 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. 

  • TRANSHUMERAL DIAGNOSTIC SOCKET

    Intake Information
    • 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:

      • 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. 

        

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

    • Due to the scan being modified, the Alignment and Modification options will not be displayed.

      Any Alignment or Modification changes can be called out in the Notes section. 

    • Since the Positive plaster model is already modified, the Alignment and Modification options will not be displayed.

      Any Alignment or Modification changes can be called out in the Notes section. 

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    • Daily HFN Capacity

    • {requestedInoffice}{requestedInoffice1448}{requestedInoffice1449}{requestedInoffice1450}

    • Requested In-Office Date: 
    • Image-1453

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

  • TRANSHUMERAL DIAGNOSTIC SOCKET

    Device Type

  • TRANSHUMERAL DIAGNOSTIC SOCKET

    Configurator
  • 0/250
    • Measurements: 
    • Patient Measurements
    • Alignment: 

    • i

      NEUTRAL is the Tibia perpendicular to the floor based on Heel Height. 

    • Final Ankle Position:

    • Set the Ankle in   *   ° of      *        

    • Final Forefoot Position:

    • Set the Forefoot in   *   ° of      *        

    • Final Hindfoot Position:

    • Set the Hindfoot in   *   ° of      *        

    • Modifications/Trimlines: 

    • Standard Mods include:

      • 1/8" (3 mm) buildup at the Malleoli, Navicular and Base of the 5th. 
      • 1/8" (3 mm) reduction at the Medial Longitudinal Arch Apex. 
    • Materials/Design: 
    • Image-1299
    • Image-1294
    • Image-1295
    • Image-1438

    • i

      Finshed Plastic thickness will be within 10% of requested thickness.

    • Inner Socket:

    • Standard Anchor Placement/Quantity:

      • 4 Anchors
      • Location:
        • 1 Anterior Wing
        • 1 Posterior Wing
        • 1 Proximal Axilla
        • 1 Distal Lateral

    • Outer Frame

    • Padding: 

    • Additional Padding

    • Finishing: 
    • Image-1065
    • Image-1069
    • Image-1142

  • TRANSHUMERAL 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 LEO portal)

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

    (No Entry required at the LEO 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. 

      

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