_BiaCare_Catalog | 页面 64

ChipVest™

P: 866.931.0876
F: 866.931.0052
[e-mail]

Measure & Order Form

PO#:

Date:

Company:
Phone:

Contact Name:
Patient:

Sex:

Age:

Ht:

Wt:

Bill-To Name & Address:
Ship-To Name & Address:

STYLE

Left Side (Unilateral)

Full (Bilateral)

Right Side (Unilateral)

CHANNEL DIRECTION
Vertical

Horizontal

Measurements to be
taken in centimeters.

SIZING & ITEM NUMBERS

X-SMALL SMALL MEDIUM LARGE X-LARGE XX-LARGE
71 - 81 81 - 91 91 - 101 101 - 111 111 - 121 121 - 131

MEASURING INSTRUCTIONS

D
A 52 - 70 62 - 80 72 - 90 82 - 100 92 - 110 102 - 120
A1 76 - 96 86 - 106 96 - 116 106 - 126 116 - 136 126 - 146
Short: 32 - 35
Regular: 35 - 38
Long: 38 - 41
X-Long: 41 - 44
L
FULL 2730-V
LEFT 2730-VL
RIGHT 2730-VR

VERTICAL CHANNELS:

2731-V

2732-V

2733-V

2734-V

2731-VL

2732-VL

2733-VL

2734-VL

2732-VR

2733-VR

2734-VR

to the waist and record in box L.

2. Measure circumferences at D, A, and A1 and

record in the appropriate boxes.

3. Use charts to determine size/item number.

2735-VL

2731-VR

1. Measure the Length from the suprasternal notch

2735-VR

HORIZONTAL CHANNELS:

FULL 2730-H
2731-H
2732-H
LEFT 2730-HL 2731-HL 2732-HL
RIGHT 2730-HR 2731-HR 2732-HR

2733-H

2735-V

2733-HL

2734-H
2734-HL

2735-H
2735-HL

2733-HR

2734-HR

2735-HR

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F: 866.931.0052

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