03.03.2013 Views

NEW - Orto Finland

NEW - Orto Finland

NEW - Orto Finland

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

Company stamp<br />

Date: Orthotist‘s name:<br />

Patient information:<br />

Diagnosis: Application:<br />

Fax no. +49(0)36628663377<br />

Measurement Sheet for<br />

Hand Orthoses<br />

Name: Sex: M F Age: Size: Weight:<br />

Side<br />

left<br />

right<br />

Model selection<br />

DAHO Model 1<br />

DAHO Model 2.1<br />

DAHO Model 2.2<br />

DAHO Model 2.3<br />

DAHO Model 2.4<br />

DAHO Model 3, incl. glove<br />

DAHO Model 4<br />

DAHO Model 4 (perforated)<br />

Option für TYP 2.1–2.4<br />

Thumb extensor<br />

A<br />

cm<br />

Hand width at level of<br />

metatarsophalangeal<br />

joints<br />

small 5.5 –7.0 cm<br />

medium 7.1–8.5 cm<br />

large 8.6–11.0 cm<br />

only for Model 4<br />

X-large >11 cm

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!