BiaCare Product Catalog | Page 13

ORDER FORM

[e-mail] • P: 866.931.0876 • F: 866.931.0052

PO#:

Company:

Phone:

Contact:

Date:

Patient Name:

Age:

Ht:

Wt:

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

PRODUCT INFORMATION
ARM

LEFT

HAND OPTIONS

RIGHT

MedaHand™ (Included)

SIZE:

MedaGlove™ (Upcharge)
Dorsal Pocket Glove (Upcharge)

LENGTH:

SIZE:
ITEM #:

Use chart below

SIZING & ITEM NUMBERS
Measuring instructions on page 85

C
B1
B
A

SMALL
23 - 32
22 - 30
20 - 27
14 - 17

SHORT 1201-ARS-L

MEDIUM
28 - 37
26 - 34
24 - 31
15 - 18

LARGE
33 - 43
30 - 39
28 - 35
16 - 19

XLARGE
39 - 49
35 - 44
32 - 39
18 - 20

1203-ARS-L

1204-ARS-L

LEFT

1202-ARS-L

REG 1201-ARR-L 1202-ARR-L 1203-ARR-L 1204-ARR-L
LONG 1201-ARL-L

1202-ARL-L

1203-ARL-L

RIGHT

1204-ARL-L

SHORT 1201-ARS-R 1202-ARS-R 1203-ARS-R 1204-ARS-R
REG 1201-ARR-R 1202-ARR-R 1203-ARR-R 1204-ARR-R
LONG 1201-ARL-R 1202-ARL-R 1203-ARL-R 1204-ARL-R
Measure length along
dorsal aspect

E
A

SMALL
15 - 19
14 - 20

HAND SIZING CHART
MEDIUM
19 - 22
16 - 22

LARGE
22 - 26
18 - 24

XLARGE
26 - 29
20 - 26

RIGHT 1201-HDR-R 1202-HDR-R 1203-HDR-R 1204-HDR-R
LEFT 1201-HDR-L 1202-HDR-L 1203-HDR-L 1204-HDR-L

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