BiaCare Product Catalog | Page 27
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- BK
ORDER FORM
PO#:
Date:
Company:
Phone:
Contact Name:
Patient Name:
Sex:
Age:
Ht:
Wt:
Bill-To Name & Address:
Ship-To Name & Address:
PRODUCT INFORMATION
LEFT LEG
ACCESSORIES (additional cost):
RIGHT LEG
SIZE:
SIZE:
Cotton Socks (extra pair) Qty:
LENGTH:
LENGTH:
Silver Socks (pair) Qty:
ITEM #:
ITEM #:
COMPREBOOT SIZE:
COMPREBOOT SIZE:
SIZING CHART & ITEM NUMBERS
MEDAFIT - BK
SMALL
C1 32 - 42
C 29 - 39
Bottom of
Patella
B 24 - 34
A 20 - 29
SHORT
LENGTH (CM)
SHORT: 25 - 30
REG: 30 - 36
TALL: 36 - 42
LARGE
34 - 44
29 - 39
39 - 49
33 - 43
21 - 30
25 - 36
38 - 48
42 - 52
X-LARGE XX-LARGE
51 - 61
58 - 68
48 - 58
55 - 65
41 - 51
44 - 55
32 - 42
33 - 43
1201 - BKS 1202 - BKS 1203 - BKS 1204 - BKS 1205 - BKS
REGULAR 1201 - BKR
TALL
MEDIUM
1202 - BKR 1203 - BKR 1204 - BKR 1205 - BKR
1201 - BKT 1202 - BKT
1203 - BKT
1204 - BKT
1205 - BKT
COMPREBOOT PLUS
SMALL
REGULAR
&
I 28 - 36
J 22 - 26
K 14 - 18
LONG
28 - 36
22 - 26
19 - 23
MED/LARGE
REGULAR
39 max
30 max
18 - 20
LONG
39 max
30 max
23 - 25
XL/XXL
REGULAR
44 max
33 max
20 - 22
LONG
44 max
33 max
25 - 27
22