|
Fitter
|
Class
|
|
Left
|
cH
|
|
cH - 1
|
cG
|
|
cF
|
cE
|
|
cD
|
cC1
|
|
cC
|
L GH
|
|
L CG
|
L CF
|
|
L CE
|
L CD
|
|
L CC1
|
Right
|
|
cH
|
cH - 1
|
|
cG
|
cF
|
|
cE
|
cD
|
|
cC1
|
cC
|
|
L GH
|
L CG
|
|
L CF
|
L CE
|
|
L CD
|
L CC1
|
|
Left
|
1. cX
|
|
1. cZ
|
2. cX
|
|
2. cZ
|
3. cX
|
|
3. cZ
|
4. cX
|
|
4. cZ
|
5. cX
|
|
5. cZ
|
cA
|
|
cB
|
cC
|
|
cC1
|
cD
|
|
cE
|
L AB
|
|
L AC
|
L CC1 6cm
|
|
L CD
|
L CE
|
|
Right
|
1. cX
|
|
1. cZ
|
2. cX
|
|
2. cZ
|
3. cX
|
|
3. cZ
|
4. cX
|
|
4. cZ
|
5. cX
|
|
5. cZ
|
cA
|
|
cB
|
cC
|
|
cC1
|
cD
|
|
cE
|
L AB
|
|
L AC
|
L CC1 6cm
|
|
L CD
|
L CE
|
|
Glove/Gauntlet
|
|
|
Evaluation
|
|
|
Swelling
|
Pain/Tenderness
|
|
Donning/Doffing Issues
|
Patient Concerns
|
|
MEDI
|
Sleeve size
|
|
Length
|
Glove
|
|
Gauntlet
|
Notes
|
|
Brand
|
Sleeve size
|
|
Length
|
Glove
|
|
Gauntlet
|
Notes
|
|
JUZO
|
Sleeve size
|
|
Length
|
Glove
|
|
Gauntlet
|
Notes
|
|
Brand
|
Sleeve size
|
|
Length
|
Glove
|
|
Gauntlet
|
Notes
|
|
JOBST
|
Sleeve size
|
|
Length
|
Glove
|
|
Gauntlet
|
Notes
|
|
Brand
|
Sleeve size
|
|
Length
|
Glove
|
|
Gauntlet
|
Notes
|
|
Brand
|
Sleeve size
|
|
Length
|
Glove
|
|
Gauntlet
|
Notes
|
|
Brand
|
Sleeve size
|
|
Length
|
Glove
|
|
Gauntlet
|
Notes
|
|
PURCHASED
|
|
|
1.Item
|
Brand
|
|
Model
|
Class
|
|
Size
|
Length
|
|
Color
|
Side
|
|
Quantity
|
P/U
|
|
2.Item
|
Brand
|
|
Model
|
Class
|
|
Size
|
Length
|
|
Color
|
Side
|
|
Quantity
|
P/U
|
|
3.Item
|
Brand
|
|
Model
|
Class
|
|
Size
|
Length
|
|
Color
|
Side
|
|
Quantity
|
P/U
|
|
4.Item
|
Brand
|
|
Model
|
Class
|
|
Size
|
Length
|
|
Color
|
Side
|
|
Quantity
|
P/U
|
|
5.Item
|
Brand
|
|
Model
|
Class
|
|
Size
|
Length
|
|
Color
|
Side
|
|
Quantity
|
P/U
|
|
6.Item
|
Brand
|
|
Model
|
Class
|
|
Size
|
Length
|
|
Color
|
Side
|
|
Quantity
|
P/U
|
|
7.Item
|
Brand
|
|
Model
|
Class
|
|
Size
|
Length
|
|
Color
|
Side
|
|
Quantity
|
P/U
|
|
8.Item
|
Brand
|
|
Model
|
Class
|
|
Size
|
Length
|
|
Color
|
Side
|
|
Quantity
|
P/U
|
|
Follow up visit
|
Fitter
|
|
Notes
|
|
