Prosthetics Lower Extremities - Kinetech Medical

Polyurethane Custom Liner Shape Plus · Syme and transmalleolar amputation
Fax to the addresses of our branches throughout
the world, which are listed at the end of this catalog.
Billing Address
Shipping Address (if different than billing address)
Customer no.
Company
Address
Customer no.
Company
Address
Orthopedic technician
Com.
Patient name: _____________________________________
without
left
right
6Y416 Shape Plus Custom Liner according to
plaster cast and measurement form
Note: Repeat orders may have tolerances in the wall
thickness of ±0.5 mm.
Wall thickness
Uniform wall thickness
Tapered (wall thickness tapered from MPT and
hollow of the knee to 3 mm thick (± 1 mm))
Distal connection:
with (requires the selection of a fabric coating)
Outer coating:
with fabric Color: caucasian black
without fabric with non-stick coating or
without coating (requires that
the patient wear the liner with
lubricant to avoid the stickiness
of the liner to the skin)
Inner coating:
with non-sticky coating (not possible with
extreme residual limb contours or forms)
without coating (requires that the patient wear the
liner with lubricant to avoid the stickiness of the liner
to the skin)
Transtibial measurements
Important: Lengthen the measurement sections if necessary.
Please mark the MPT and all pronounced zones
onto the plaster model. Extend the plaster negative
15 cm beyond the knee center!
Length of res. limb cm
Comments:
Missing information may delay your order!
Replacement custom liner: Please contact your
customer service!
least
circumference
biggest
circumference
+ 10 cm
+ 5 cm
MPT
+ 5 cm
+ 10 cm
+ 15 cm
+ 20 cm
+ 25 cm
Otto Bock keeps the custom model for two years following the last
order.
Date _____________ Place _____________________________
Signature ___________________________________
Otto Bock HealthCare GmbH | Prosthetics – Lower Extremities | www.ottobock.com 275