BiaCare Product Catalog | Seite 35

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PO#:

ORDER FORM
Contact:

Company:

Phone:

Date:

Patient Name:

Age:

Ht:

Wt:

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

PRODUCT INFORMATION

LEFT LEG

Black

RIGHT LEG

Beige

Below Knee (BK)

Thigh Component (TC)

Black

Beige
Thigh Component (TC)

Below Knee (BK)

SIZE:

SIZE:

SIZE:

SIZE:

LENGTH:

ITEM #:

LENGTH:

ITEM #:

ITEM #:

ITEM #:

COMPREBOOT SIZE (page 45):

COMPREBOOT SIZE (page 45):

SIZING & ITEM NUMBERS
Measuring instructions on page 85

THIGH COMPONENT

SMALL
48 - 58
43 - 53
38 - 48

MEDIUM
56 - 66
51 - 61
46 - 56

LARGE
64 - 74
58 - 68
53 - 63

XLARGE XXLARGE
74 - 84
N/A
68 - 78
63 - 73

BLACK 1101 - TC

1102 - TC

1103 - TC

1104 - TC

N/A

BEIGE 1111 - TC

1112 - TC

1113 - TC

1114 - TC

N/A

F
E
D

BELOW KNEE - REGULAR

MEDIUM
34 - 44
29 - 39
21 - 30

LARGE
39 - 49
33 - 43
25 - 36

BLACK 1101 - BKR

1102 - BKR

1103 - BKR

1104 - BKR

1105 - BKR

BEIGE 1111 - BKR

1112 - BKR

1113 - BKR

1114 - BKR

1115 - BKR

C
B
A

C1
C
B
A

SMALL
29 - 39
24 - 34
20 - 29

XLARGE XXLARGE
55 - 65
48 - 58
44 - 55
41 - 51
33 - 43
32 - 42

BELOW KNEE - TALL

34 - 44
31 - 41
25 - 35
21 - 30

39 - 49
35 - 45
30 - 40
25 - 36

48 - 58
44 - 54
36 - 46
32 - 42

55 - 65
50 - 60
40 - 50
33 - 43

BLACK 1101 - BKT

1102 - BKT

1103 - BKT

1104 - BKT

1105 - BKT

BEIGE 1111 - BKT

1112 - BKT

1113 - BKT

1114 - BKT

1115 - BKT

29 - 39
26 - 36
21 - 31
20 - 29

Foot measuring instructions on page 45

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