BiaCare Product Catalog | Page 33

P: 866.931.0876 F: 866.931.0052 [email protected] PO#: ChipSleeve TM ORDER FORM - TH Date: Company: Phone: Contact Name: Patient Name: Sex: Age: Ht: Wt: Bill-To Name & Address: Ship-To Name & Address: PRODUCT INFORMATION LEFT LEG OVERSLEEVE (included): RIGHT LEG SIZE: SIZE: Black Pink Leopard LENGTH: LENGTH: Navy Tie-Dye Purple Paisley ITEM #: ITEM #: Note: If no color is specified, a black OverSleeve™ will be included. SIZING CHART & ITEM NUMBERS Gluteal Fold (or desired length) CHIPSLEEVE - TH F E D C1 C B A LEFT LENGTH (CM) SHORT: 61 - 71 REG: 71 - 81 TALL: 81 - 91 X - LARGE 74 - 84 68 - 78 63 - 73 32 - 42 37 - 47 42 - 52 51 - 61 29 - 39 34 - 44 39 - 49 48 - 58 24 - 34 29 - 39 33 - 43 41 - 51 20 - 29 21 - 30 25 - 36 32 - 42 MEDIUM 56 - 66 SHORT 2631-THS-L 2632-THS-L 2633-THS-L 2634-THS-L REG 2631-THR-L 2632-THR-L 2633-THR-L 2634-THR-L TALL 2631-THT-L 2632-THT-L 2633-THT-L 2634-THT-L SHORT 2631-THS-R 2632-THS-R 2633-THS-R 2634-THS-R RIGHT H 51 - 61 46 - 56 LARGE 64 - 74 58 - 68 53 - 63 SMALL 48 - 58 43 - 53 38 - 48 REG 2631-THR-R 2632-THR-R 2633-THR-R 2634-THR-R TALL 2631-THT-R 2632-THT-R 2633-THT-R 2634-THT-R 24