patient set-up form extremities v4 - 31924 · 2019. 2. 22. · patient id: date: for more...
TRANSCRIPT
Patient ID:
Date:
for more information please visit our website at www.orfit.com
Knee Mask (35793/32MA)
o No
Position leg support
o Right
o Left
Position of the leg support on the baseplate
o Yes
o No
Position comfort cushions
Treatment area:o Left Arm
Foot Mask (35792/32MA)
Hand Mask (35794/2MI)
o Right Arm
Base Plate
o Yes
o No
Leg Support
o Yes
Extremities Solution
Individual patient components list (1)
o Yes
o Right Leg
o Left Leg
Position of the baseplate on the table
o Yes
o No
o Hand
Comfort Cushions
o Heel
o Elbow
o Knee
Elbow Mask - Curved (35794/2MI)Elbow Mask - Straight (35795/2MI)
o No
Art. No.32103 - V4 - 17/01/2019
o Yes o Yes
o No o No
o Yes
5-points shoulder mask right (35799/2MI/R) 5-points shoulder mask left (35799/2MI/L)
o Yes
o No o No
All
Rig
hts
rese
rved
.No
par
to
fth
isp
ub
licat
ion
may
be
pro
du
ced
,sto
red
ina
retr
ieva
lsys
tem
or
tran
smit
ted
,in
any
way
,fo
rmo
rb
yan
ym
ean
s,el
ecto
nic
,mec
han
ical
,ph
oto
cop
yin
go
ro
ther
wis
e,w
ith
ou
tp
rio
rw
ritt
enp
erm
issi
on
of
Orf
itIn
du
stri
es©
OR
FIT
Ind
ust
ries
Patient ID:
Date:
for more information please visit our website at www.orfit.com
Draw the location of the masks and the 2-pin bar on the baseplate
Art. No. 31924 - V3 - 13/03/2014
Individual patient components list (2)Extremities Solution
All
Rig
hts
rese
rved
.No
par
to
fth
isp
ub
licat
ion
may
be
pro
du
ced
,sto
red
ina
retr
ieva
lsys
tem
or
tran
smit
ted
,in
any
way
,fo
rmo
rb
yan
ym
ean
s,el
ecto
nic
,mec
han
ical
,ph
oto
cop
yin
go
ro
ther
wis
e,w
ith
ou
tp
rio
rw
ritt
enp
erm
issi
on
of
Orf
itIn
du
stri
es©
OR
FIT
Ind
ust
ries
Patient ID:
Date:
for more information please visit our website at www.orfit.com
Extremities SolutionIndividual patient components list (3)
Draw the location of the masks on the leg support
Art. No. 31924 - V3 - 13/03/2014
All
Rig
hts
rese
rved
.No
par
to
fth
isp
ub
licat
ion
may
be
pro
du
ced
,sto
red
ina
retr
ieva
lsys
tem
or
tran
smit
ted
,in
any
way
,fo
rmo
rb
yan
ym
ean
s,el
ecto
nic
,mec
han
ical
,ph
oto
cop
yin
go
ro
ther
wis
e,w
ith
ou
tp
rio
rw
ritt
enp
erm
issi
on
of
Orf
itIn
du
stri
es©
OR
FIT
Ind
ust
ries