Form 2, Form 3 - Hands And Arms - Voe, S.a.
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1
2FORM Nº2
VOE, S.A.
Aribau, 39. 08011 Barcelona (Spain)
Tel. +34 93 451 64 52
Fax +34 93 451 76 22
info@voe.es
Date:
Nº:
Patient:
Age*:
Male
Female
Weight*:
Height*:
Replacement
IMPORTANT: You must attach a picture of injury or draw it in the sketch. *Required data.
Nº units:
Nº units:
Nº units:
Nº units:
Ref. 9203
Ref. 9204
Ref. 9208
Ref. 9205
Closed glove
Open glove
Mitt
Glove to elbow
R
L
R
L
R
L
Mitt
Open
Closed
R
L
16
17
Circumferences
Lenghts
R
L
R
L
9
15
11
18
7
1
At fold
15
10
12
8
2
Palm
16
13
14
3
Wrist
17
1
19
4
Half sleeve
18
6
23
22
21
5
Upper end
19
From base to tip of thumb
2
20
6
Tip of thumb
20 From base to thumb of wrist
3
7
21
4
24
8
22
5
9
23
10
24 Lenght of sleeve
11
Comments
12
Velcro fastener
Zip fastener
13
14
Position:
Cubital
Radial
Dorsal
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Parent category: Education