SHIP TO: ________________________________________________ ________________________________________________________ ________________________________________________________ P.O.#___________________________ DATE___________________
ANKLE AND FOOT SUPPORTS PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT UNLESS OTHERWISE SPECIFIED, THE BELOW BRACES ARE BILATERAL PRODUCT CODE
UNIV.
XXS
ASO EVO - BLACK
26409-X
N/A
N/A
N/A
ASO EVO - WHITE
26408-X
N/A
N/A
N/A
ASO EVO - HINGE ONLY
26413-X
N/A
N/A
N/A
ASO EVO SPEEDLACER - BLACK
26411-X
N/A
N/A
N/A
ASO EVO QUATRO - BLACK
26423-X
N/A
N/A
N/A
ASO WITH STAYS - BLACK
26403-X
N/A
N/A
N/A
ASO WITH STAYS - WHITE
22318-X
N/A
N/A
N/A
ASO WITHOUT STAYS - BLACK
26401-X
N/A
ASO SPEEDLACER - BLACK
22361-X
N/A
N/A
ASO SPEEDLACER - WHITE
22360-X
N/A
N/A
ASO VORTEX - BLACK
26417-X
N/A
N/A
N/A
ASO MAX - BLACK
26404-X
N/A
N/A
N/A
ASO FLEX-HINGE - BLACK
26407-X
N/A
N/A
N/A
PHANTOM DORSAL NIGHT SPLINT
26412-X
N/A
N/A
N/A
TOE PULL STRAP FOR PHANTOM NIGHT SPLINT
264120
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
PFO-PLANTAR FACITIS ORTHOSIS
264110
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
POST-OP SHOE - MALE
40318-X
N/A
N/A
N/A
N/A
N/A
POST-OP SHOE - FEMALE
40320-X
N/A
N/A
N/A
N/A
N/A
ROCKER BOTTOM CAST SHOE
40364-X
N/A
N/A
N/A
SQUARE TOE MED-SURG SHOE - MODEL 447 - WOMEN'S
447-1X
N/A
N/A
N/A
N/A
SQUARE TOE MED-SURG SHOE - MODEL 447 - MEN'S
447-2X
N/A
N/A
N/A
N/A
FULL SHELL TALL PNEUMATIC WALKER BOOT
T9802-X
N/A
N/A
N/A
N/A
N/A
N/A
FULL SHELL SHORT PNEUMATIC WALKER BOOT
T9812-X
N/A
N/A
N/A
N/A
N/A
N/A
FIXED CAM WALKER BOOT
T2002-X
N/A
N/A
N/A
N/A
N/A
SHORT FIXED CAM WALKER BOOT
T2102-X
N/A
N/A
N/A
N/A
N/A
N/A
34108001-X
N/A
N/A
N/A
N/A
N/A
N/A
4457xx
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
ELEMENTS STRETCH-UP M2 NIGHT SPLINT STANDARD 3 INCH X 9-1/16 INCH 3/4 LENGTH HEEL WEDGE/LIFT
HWL
XS
LG
XL
XXL
XXXL
N/A N/A
N/A
N/A
N/A
N/A
N/A
ELASTIC ANKLE SUPPORT WITH GEL PADS
OS6240-X
N/A
N/A
N/A
TOB-500N-X
N/A
N/A
TN-240-X
N/A
N/A
N/A
N/A
N/A
N/A
20744-II-X
TN-240 ELASTIC ANKLE SUPPORT
MD
N/A
RMI SAFEBOOT II
CROSSOVER ELASTIC ANKLE SUPPORT
SM
N/A
N/A
N/A
N/A
N/A
05/17/16
SHIP TO: ________________________________________________ ________________________________________________________ ________________________________________________________ P.O.#___________________________ DATE___________________
ANKLE AND FOOT SUPPORTS - CONTINUED PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT UNLESS OTHERWISE SPECIFIED, THE BELOW BRACES ARE BILATERAL
NEUROFLEX RESTORATIVE FLEXBOOT (PEDIATRIC SAFEBOOT)
PRODUCT CODE
UNIV.
20746-X
N/A
3"
3 1/2"
PRODUCT CODE
UNIVERSAL AIR GEL STIRRUP
4"
5"
6"
7"
8"
MD
LG
XL
XXL
ADULT
2232-X PRODUCT CODE
S/M
L/XL
PRODUCT CODE
UNIV
XXS
AKS WITH PLASTIC HINGES - COOLFLEX
11710-X
N/A
N/A
AKS WITH METAL HINGES AND STRAPS - COOLFLEX
11712-X
N/A
N/A
DYNATRACK PLUS PATELLA STABILIZER W/PLASTIC HINGES - NEOPRENE
11700-X
N/A
N/A
DYNATRACK PLUS PATELLA STABILIZER W/PLASTIC HINGES - COOLFLEX
11702-X
N/A
N/A
DYNATRACK PATELLA STABILIZER W/ METAL HINGES COOLFLEX LEFT
11704-X
N/A
N/A
N/A
DYNATRACK PATELLA STABILIZER W/ METAL HINGES COOLFLEX RIGHT
11705-X
N/A
N/A
N/A
GRIPPER HINGED KNEE 12" - NEOPRENE
11701-X
N/A
N/A
GRIPPER HINGED KNEE 12" - COOLFLEX
11703-X
N/A
N/A
GRIPPER HINGED KNEE 16" - ALUMINUM HINGES NEOPRENE
11707-X
N/A
N/A
N/A
GRIPPER HINGED KNEE 16" - ALUMINUM HINGES COOLFLEX
11708-X
N/A
N/A
N/A
GRIPPER HINGED KNEE 16" - ROM HINGES - COOLFLEX
11714-X
N/A
N/A
N/A
PATELLAVATOR
22362-X
N/A
N/A
N/A
PADDED KNEE SLEEVE
11706-X
N/A
N/A
FORGE EXTENDER POST-OP OPEN
425490
LEG PROTECTION SLEEVE (SOLD BY THE PAIR)
20600
LEG PROTECTION SLEEVE (SOLD BY THE CASE OF 12 PAIRS)
20612
UNIVERSAL FOAM KNEE IMMOBILIZER - 12"
NAVIGAIT DROP FOOT ORTHOSIS
4459-X
KNEE, THIGH, AND CALF SUPPORTS PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT UNLESS OTHERWISE SPECIFIED, THE BELOW BRACES ARE BILATERAL XS
SM
XXXL
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
223690
UNIVERSAL FOAM KNEE IMMOBILIZER - 16"
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
223660
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
UNIVERSAL FOAM KNEE IMMOBILIZER - 18"
223665
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
UNIVERSAL FOAM KNEE IMMOBILIZER - 20"
223670
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
UNIVERSAL FOAM KNEE IMMOBILIZER - 22"
223675
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
05/17/16
SHIP TO: ________________________________________________ ________________________________________________________ ________________________________________________________ P.O.#___________________________ DATE___________________
KNEE, THIGH, AND CALF SUPPORTS - CONTINUED PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT UNLESS OTHERWISE SPECIFIED, THE BELOW BRACES ARE BILATERAL PRODUCT CODE
UNIV
XXS
XS
SM
MD
LG
XL
XXL
XXXL
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
UNIVERSAL FOAM KNEE IMMOBILIZER - 24"
223680
RODISIL CLOSED PATELLA KNEE BRACE WITH POLYCENTRIC HINGE
9106-X
N/A
N/A
RODISIL CLOSED PATELLA KNEE BRACE WITH LATERAL STABILIZERS
9104-X
N/A
N/A
ELASTIC KNEE SUPPORT WITH LATERAL STABILIZERS
OS6211-X
N/A
N/A
N/A
N/A
N/A
N/A
ELASTIC CALF SUPPORT
OS6804-X
N/A
N/A
N/A
N/A
N/A
N/A
ELASTIC THIGH SUPPORT
OS6801-X
N/A
N/A
N/A
N/A
N/A
N/A
ELASTIC KNEE SUPPORT
TN-210-X
N/A
N/A
N/A
N/A
N/A
N/A
PRODUCT CODE
SM/MD
LG/XL
2XL/3XL
PRODUCT CODE
UNIV
XXS
XS
COMFIHIPS HIP PROTECTOR SET - WOMENS'
CH-W-X
N/A
N/A
N/A
COMFIHIPS HIP PROTECTOR SET - MENS'
CH-M-X
N/A
N/A
N/A
COMFIHIPS UNDERGARMENT- WOMENS' (2/PK)
CH-W-X-UG
N/A
N/A
N/A
COMFIHIPS UNDERGARMENT- MENS' (2/PK)
CH-M-X-UG
N/A
N/A
N/A
AIRSHIFT OA KNEE BRACE - LEFT MEDIAL/RIGHT LATERAL
11718-X
AIRSHIFT OA KNEE BRACE - RIGHT MEDIAL/LEFT LATERAL
11719-X
HIP PROTECTORS AND SUPPORTS PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT SM
MD
LG
XL
XXL
XXXL
COMFIHIPS REPLACEMENT PAD (2/PK)
CH-PAD
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
HIP ABDUCTION PILLOW
333094
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
BACK SUPPORTS PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT
** LARGEST SIZE MAY BE MORE EXPENSIVE - PLEASE CALL FOR INFORMATION PRODUCT CODE
UNIV
XXS
XS
ARCHIMED SPINAL BRACE 631
16331-X
N/A
N/A
N/A
ARCHIMED SPINAL BRACE 631 UNIVERSAL
163310
N/A
N/A
ARCHIMED JR. 627 SPINAL BRACE
16332-X
N/A
N/A
ARCHIMED JR. 627 SPINAL BRACE UNIVERSAL
163320
N/A
N/A
ARCHIMED 637 SPINAL BRACE
16333-X
N/A
N/A
N/A
BACK N' BLACK **
16320-X
N/A
N/A
BACK N' BLACK LOW PROFILE
16324-X
N/A
N/A
N/A
BACK N' BLACK W/ THERMOFORMABLE POCKET
16322-X
N/A
N/A
N/A
N/A
SM
MD
LG
XL
XXL
XXXL
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
05/17/16
SHIP TO: ________________________________________________ ________________________________________________________ ________________________________________________________ P.O.#___________________________ DATE___________________
BACK SUPPORTS - CONTINUED PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT
** LARGEST SIZE MAY BE MORE EXPENSIVE - PLEASE CALL FOR INFORMATION PRODUCT CODE
UNIV
XXS
XS
BACK N' BLACK DUAL PANEL
16325-X
N/A
N/A
N/A
BACK N' SHAPE II WITH DOUBLE SIDE PULLS
16303-X
N/A
N/A
N/A
SACROILIAC (S.I.) BELT
16330-X
N/A
N/A
N/A
N/A
COOLER BELT **
0200-X
N/A
N/A
N/A
N/A
LUMBO THORACIC - LONG
0240-X
N/A
N/A
N/A
LUMBO THORACIC - SHORT
0241-X
N/A
N/A
N/A
MOTHER TO BE **
0055-X
N/A
N/A
N/A
LOVING COMFORT MATERNITY SUPPORT
0230-X
N/A
N/A
N/A
POST PARTUM SUPPORT
0250-X
N/A
N/A
N/A
0130 BEI-X
N/A
N/A
SPINA 1201 - LIGHTWEIGHT SPINAL ORTHOSIS- FEMALE
1201-F-X
N/A
N/A
N/A
N/A
N/A
SPINA 1200 - LIGHTWEIGHT SPINAL ORTHOSIS - MALE
1200-M-X
N/A
N/A
N/A
N/A
N/A
SPINA II 1276 - KNIGHT TAYLOR SPINAL ORTHOSIS FEMALE
1276-W-X
N/A
N/A
N/A
N/A
N/A
SPINA II 1275 - KNIGHT TAYLOR SPINAL ORTHOSIS - MALE
1275-M-X
N/A
N/A
N/A
N/A
N/A
CRISS CROSS BEIGE **
SM
MD
LG
XL
XXL
XXXL N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A N/A
SPINA II FRONT PANEL - FEMALE
1206F
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
SPINA II FRONT PANEL - MALE
1206M
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
0101 MOLDABLE INSERT (MEDSPEC 163000 COMPATIBLE)
0101 WHI UN
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
0110 MOLDABLE INSERT
0110 WHI UN
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
PRODUCT CODE
XS/SM
XL
XXL
XXXL
N/A
N/A
N/A
N/A
N/A
N/A
CRISS CROSS WHITE
MD/LG
XL/2XL
0130 WHI-X
BELTS AND BINDERS PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT PRODUCT CODE
UNIV
UNIVERSAL ELASTIC RIB BELT
1632-X
N/A
MALE
FEMALE
UNIV. 9" ELASTIC ABDOMINAL BINDER
163280
N/A
N/A
UNIV. 12" ELASTIC ABDOMINAL BINDER
163290
N/A
N/A
CERVICAL AND CLAVICLE SUPPORTS PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT PRODUCT CODE
UNIV.
XXS
XS
CONTOUR COLLAR
12304-X
N/A
N/A
N/A
CONTOUR CLAVICLE STRAP
14384-X
N/A
CAROLINA COLLAR
12325-X
N/A
N/A
N/A
SM
MD
LG
N/A
05/17/16
SHIP TO: ________________________________________________ ________________________________________________________ ________________________________________________________ P.O.#___________________________ DATE___________________
CERVICAL AND CLAVICLE SUPPORTS - CONTINUED PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT
NEUROFLEX RESTORATIVE KENTUCKY KOLLAR
CERVICAL UNIVERSAL COLLAR
PRODUCT CODE
UNIV.
XXS
XS
20735-X
N/A
N/A
N/A
PRODUCT CODE
3"
4"
SM
MD
LG
XL
XXL
XXXL
N/A
N/A
XXL
XXXL
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
1231-X
SHOULDER AND ARM SUPPORTS PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT UNLESS OTHERWISE SPECIFIED, THE BELOW BRACES ARE BILATERAL** LARGEST SIZE MAY BE MORE EXPENSIVE - PLEASE CALL FOR INFORMATION PRODUCT CODE
UNIV
XXS
XS
SM
MD
LG
XL
PADDED ARM SLING - BLACK **
18336-X
UNIVERSAL HEMI-SLING
183010
N/A
SHOULDER IMMOBILIZER **
18337-X
N/A
OUTRIGGER II SHOULDER IMMOBILIZER
18375-X
N/A
N/A
N/A
VECTOR ABDUCTED SHOULDER SLING - LEFT
18370-X
N/A
N/A
N/A
N/A
N/A
N/A
VECTOR ABDUCTED SHOULDER SLING - RIGHT
18371-X
N/A
N/A
N/A
N/A
N/A
N/A
VISSION SHOULDER STABILIZER
310390
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
FOAM SLING & SWATHE SHOULDER IMMOBILIZER
183600
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
ARM PROTECTION SLEEVE (SOLD BY THE PAIR)
10-x-00
N/A
N/A
N/A
N/A
N/A
ARM PROTECTION SLEEVE (SOLD BY THE CASE OF 12 PAIRS)
10-x-12
N/A
N/A
N/A
N/A
N/A
VISSION MESH CONTOURED SLING
3101xx
N/A
N/A
N/A
N/A
N/A
HFB-OS-x00-X
N/A
N/A
N/A
N/A
N/A
PRODUCT CODE
UNIV
XXS
XS
XL
XXL
XXXL
0605 BLA-X
N/A
N/A
N/A
OS6230-X
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
OVER THE SHOULDER-NEUTRAL HFB..EXTENDED VERSION
N/A
N/A
N/A
N/A
N/A
ELBOW SUPPORTS PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT UNLESS OTHERWISE SPECIFIED, THE BELOW BRACES ARE BILATERAL
TENNIS ELBOW SLEEVE ELASTIC ELBOW SUPPORT WITH GEL PADS EPITEC ELBOW BAND TN-230 ELASTIC ELBOW SUPPORT
EP-21G TN-230-X
N/A
N/A
N/A
PRODUCT CODE
UNIV.
SM.MD
LG/XLG
EPIGEL ELBOW SUPPORT
223410
N/A
N/A
EPIFOAM ELBOW SUPPORT
223420
N/A
N/A
CUBITAL TUNNEL BRACE
22344-x
SM/MD
LG/XL
SM
N/A
MD
N/A
LG
N/A
N/A
PRODUCT CODE
XS
EPILOCK TENNIS ELBOW
1013 BEI-X
N/A
RADIAL TENNIS ELBOW
0610 BLA-X
XXL N/A
05/17/16
SHIP TO: ________________________________________________ ________________________________________________________ ________________________________________________________ P.O.#___________________________ DATE___________________
WRIST, HAND AND THUMB SUPPORTS PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT UNLESS OTHERWISE SPECIFIED, THE BELOW BRACES ARE BILATERAL PRODUCT CODE
UNIV
XXS
XS
SM
MD
LG
XL
XXL
XXXL
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
SUEDE WRIST LACER - 8" BLACK LEFT
22392-X
SUEDE WRIST LACER - 8" BEIGE LEFT
22322-X
SUEDE WRIST LACER - 8" BLACK RIGHT
22393-X
SUEDE WRIST LACER - 8" BEIGE RIGHT
22323-X
SUEDE WRIST LACER - 10.5" BLACK LEFT
22395-X
SUEDE WRIST LACER - 10.5" BEIGE LEFT
22355-X
SUEDE WRIST LACER - 10.5" BLACK RIGHT
22396-X
SUEDE WRIST LACER - 10.5" BEIGE RIGHT
22356-X
N/A
SUEDE WRIST LACER II - 8" BLACK LEFT
22332-X
N/A
N/A
SUEDE WRIST LACER II - 8" BLACK RIGHT
22333-X
N/A
N/A
TRIPOD 8" WRIST LACER - LEFT
22330-X
N/A
N/A
N/A
N/A
TRIPOD 8" WRIST LACER - RIGHT
22331-X
N/A
N/A
N/A
N/A
BOXER SPLINT WRIST SUPPORT - LEFT
22357-X
N/A
N/A
N/A
N/A
N/A
BOXER SPLINT WRIST SUPPORT - RIGHT
22358-X
N/A
N/A
N/A
N/A
N/A
COMPRESSOR WRIST SUPPORT - LEFT
22380-X
N/A
N/A
N/A
N/A
N/A
COMPRESSOR WRIST SUPPORT - RIGHT
22381-X
N/A
N/A
N/A
N/A
N/A
GELFLEX WRIST - LEFT
22382-X
N/A
N/A
N/A
N/A
N/A
GLEFLEX WRIST - RIGHT
22383-X
N/A
N/A
N/A
N/A
N/A
MOTION MANAGER UNIVERSAL WRIST
22390-X
N/A
N/A
N/A
N/A
V-STRAP 8" WRIST LACER - LEFT
22324-X
N/A
N/A
V-STRAP 8" WRIST LACER - RIGHT
22325-X
N/A
N/A
WRIST ORTHOSIS WITH MODLABLE INSERT - LEFT
3920-x-L
N/A
N/A
N/A
N/A
N/A
N/A
WRIST ORTHOSIS WITH MODLABLE INSERT - RIGHT
3920-x-R
N/A
N/A
N/A
N/A
N/A
N/A
RESTORATIVE HAND ADULT - LEFT
20736-X
N/A
N/A
N/A
N/A
RESTORATIVE HAND ADULT - RIGHT
20736-X
N/A
N/A
N/A
N/A
MODIFIED RESTORATIVE HAND - LEFT
20736-X - MOD
N/A
N/A
N/A
N/A
N/A
N/A
MODIFIED RESTORATIVE HAND - RIGHT
20736-X - MOD
N/A
N/A
N/A
N/A
N/A
N/A
WRIST HAND ORTHOSIS - LEFT
WHO-Lx
N/A
N/A
N/A
N/A
N/A
N/A
WRIST HAND ORTHOSIS - RIGHT
WHO-Rx
N/A
N/A
N/A
N/A
N/A
N/A
FUNCTIONAL POSITIONING ORTHOSIS - LEFT
FPO-Lx
N/A
N/A
N/A
N/A
N/A
N/A
FUNCTIONAL POSITIONING ORTHOSIS - RIGHT
FPO-Rx
N/A
N/A
N/A
N/A
N/A
N/A
RYNO LACER WRIST/THUMB - BLACK SHORT LEFT
22388-X
N/A
N/A
N/A
RYNO LACER WRIST/THUMB - BEIGE SHORT LEFT
22386-X
N/A
N/A
N/A
RYNO LACER WRIST/THUMB - BLACK SHORT RIGHT
22389-X
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
05/17/16
SHIP TO: ________________________________________________ ________________________________________________________ ________________________________________________________ P.O.#___________________________ DATE___________________
WRIST, HAND AND THUMB SUPPORTS - CONTINUED PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT UNLESS OTHERWISE SPECIFIED, THE BELOW BRACES ARE BILATERAL PRODUCT CODE
UNIV
XXS
XXL
XXXL
RYNO LACER WRIST/THUMB - BEIGE SHORT RIGHT
22387-X
N/A
N/A
N/A
N/A
RYNO LACER WRIST/THUMB - BLACK LONG LEFT
22398-X
N/A
N/A
N/A
RYNO LACER WRIST/THUMB - BEIGE LONG LEFT
22378-X
N/A
N/A
N/A
RYNO LACER WRIST/THUMB - BLACK LONG RIGHT
22399-X
N/A
N/A
N/A
RYNO LACER WRIST/THUMB - BEIGE LONG RIGHT
22379-X
N/A
N/A
N/A
N/A
OS6260-X
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
ELASTIC WRIST SUPPORT
N/A
XS
SM
MD
LG
XL
ADJUSTABLE WRIST SUPPORT
OS6261
CMC THUMB SUPPORT - LEFT
22442-X
N/A
N/A
N/A
N/A
CMC THUMB SUPPORT - RIGHT
22443-X
N/A
N/A
N/A
N/A
7.5" SUEDE THUMB SUPPORT
223180
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
9" SUEDE THUMB SUPPORT
223190
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
TEE PEE THUMB SUPPORT
22308-X
N/A
N/A
N/A
N/A
BREATHABLE THUMB IMMOBILIZING SPLINT
M770X
N/A
N/A
N/A
N/A
N/A
N/A
WRIST HAND THUMB ORTHOSIS - LEFT
WHTO-Lx
N/A
N/A
N/A
N/A
N/A
N/A
WRIST HAND THUMB ORTHOSIS - RIGHT
WHTO-Rx
N/A
N/A
N/A
N/A
N/A
N/A
ELASTIC THUMB SUPPORT - LEFT
22440-X
N/A
N/A
N/A
N/A
N/A
N/A
ELASTIC THUMB SUPPORT - RIGHT
22441-X
N/A
N/A
N/A
N/A
N/A
N/A
THUMB GUARD SPICA - LEFT
TGS-x
N/A
N/A
N/A
N/A
N/A
N/A
THUMB GUARD SPICA - RIGHT
TGS-x
N/A
N/A
N/A
N/A
N/A
N/A
CMC CARE THUMB BRACE LEFT
8712Lx
N/A
N/A
N/A
N/A
N/A
N/A
CMC CARE THUMB BRACE RIGHT
8712Rx
N/A
N/A
N/A
N/A
N/A
N/A
FINGER IMMOBILIZING GLOVE SPLINT
M710D-X
N/A
N/A
N/A
N/A
N/A
FINGER IMMOBILIZING GLOVE SPLINT
M710I-X
N/A
N/A
N/A
N/A
N/A
MANUTEC BREATHABLE THUMB IMMOBILIZING SPLINT RIGHT
FP-D74-X
N/A
N/A
N/A
N/A
N/A
N/A
MANUTEC BREATHABLE THUMB IMMOBILIZING SPLINT LEFT
FP-I74-X
N/A
N/A
N/A
N/A
N/A
N/A
PRODUCT CODE
INFANT
TODDLER JR.
TODDLER
CHILD
YOUTH
CHILD
TODDLER
YOUTH
RESTORATIVE HYPER HAND - LEFT
20717-X
RESTORATIVE HYPER HAND - RIGHT
20717-X PRODUCT CODE
MODIFIED RESTORATIVE HYPER HAND - LEFT
20717-X - MOD
MODIFIED RESTORATIVE HYPER HAND - RIGHT
20717-X - MOD
N/A
N/A
N/A
N/A
05/17/16
SHIP TO: ________________________________________________ ________________________________________________________ ________________________________________________________ P.O.#___________________________ DATE___________________
WRIST, HAND AND THUMB SUPPORTS - CONTINUED PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT UNLESS OTHERWISE SPECIFIED, THE BELOW BRACES ARE BILATERAL PRODUCT CODE
ADULT
CHILD
TODDLER
YOUTH
N/A
N/A
NEUROFLEX RESTORATIVE FLEX HAND - LEFT
20721L
N/A
NEUROFLEX RESTORATIVE FLEX HAND - RIGHT
20721R
N/A
N/A
N/A
NEUROFLEX RESTORATIVE FLEX HAND - LEFT REVERSE CONES
20721LRC
N/A
N/A
N/A
NEUROFLEX RESTORATIVE FLEX HAND - RIGHT REVERSE CONES
20721RRC
N/A
N/A
N/A
NEUROFLEX RESTORATIVE PEDIATRIC FLEX HAND - LEFT
20720X
N/A
NEUROFLEX RESTORATIVE PEDIATRIC FLEX HAND RIGHT
20720X
N/A
NEUROFLEX RESTORATIVE PEDIATRIC FLEX HAND - LEFT REVERSE CONES
20720X
N/A
NEUROFLEX RESTORATIVE PEDIATRIC FLEX HAND RIGHT REVERSE CONES
20720X
N/A
PRODUCT CODE
UNIV
LINER FOR 8002 FIXED CAM WALKER
8200-X
N/A
N/A
N/A
N/A
N/A
N/A
LINER FOR 8022 SHORT FIXED CAM WALKER
8220-X
N/A
N/A
N/A
N/A
N/A
N/A
9010-LINER-X
N/A
N/A
N/A
N/A
N/A
N/A
FORRO-FP74-x
N/A
N/A
N/A
N/A
N/A
N/A
REPLACEMENT LINERS AND STRAPS PLEASE INDICATE A QUANTITY WHEN SELECTING A PRODUCT
LINER FOR 9010 PNEUMATIC WALKER LINER FOR FP74 THUMB SPLINT - Sizes SM to LG
SM
MD
LG
COMMENTS
PLEASE FAX YOUR ORDER TO 1-888-484-4431 OR EMAIL TO
[email protected] 05/17/16
