Embed Size (px)
Citation preview
JOBST® FarrowWrap®
Ordering Form
How to measure
JOBST® FarrowWrap® RTW Legpiece size chart
JOBST® FarrowWrap® RTW Thighpiece size chart
XSmall Small Medium Large XLarge
Ready-to-wear pieces
Thighpiece
G Groin 60 - 70 cm 65 - 75 cm 70 - 80 cm 75 - 90 cm 85 - 100 cm
E Above Knee 47 - 52 cm 53 - 59 cm 60 - 66 cm 67 - 73 cm 74 - 80 cm
E-G Short 16 - 20 cm 16 - 20 cm 16 - 20 cm 16 - 20 cm 16 - 20 cm
E-G Regular 21 - 26 cm 21 - 26 cm 21 - 26 cm 21 - 26 cm 21 - 26 cm
E-G Tall 27 - 31 cm 27 - 31 cm 27 - 31 cm 27 - 31 cm 27 - 31 cm
Length E-G = Measure MEDIALLY from just above patella to the groin. Follow outer contour of any skin folds/lobules.
JOBST® FarrowWrap® RTW Footpiece size chart
XSmall Small Medium Large XLarge
Ready-to-wear pieces
Footpiece
A Mid-foot 22 - 24 cm 25 - 27 cm 28 - 30 cm 31 - 34 cm 35 - 40 cm
X Regular 15 - 17 cm 16 - 19 cm 18 - 20 cm 19 - 22 cm 21 - 24 cm
X Tall 18 - 20 cm 20 - 22 cm 21 - 23 cm 23 - 25 cm 25 - 27 cm
The length is measured from the most posterior aspect of the heel to the base of the 5th toe.
XSmall Small Medium Large XLarge
Ready-to-wear pieces
Legpiece
C Calf 36 - 43 cm 42 - 50 cm 48 - 58 cm 53 - 63 cm 58 - 68 cm
B Ankle 21 - 25 cm 25 - 30 cm 30 - 36 cm 36 - 42 cm 42 - 50 cm
A-D Regular 35 - 39 cm 37 - 41 cm 39 - 43 cm 41 - 45 cm 42 - 46 cm
A-D Tall 40 - 44 cm 42 - 46 cm 44 - 48 cm 46 - 50 cm 47 - 51 cm
Length A-D = Floor to 2 finger widths below crease of knee. Measure posteriorly FOLLOWING contour of leg.
Xsmall Small Medium Large X Large
5cm above patella 47 - 52cm 53 - 59cm 60 - 66cm 67 - 73cm 74 - 80cm
Calf 36 - 43cm 42 - 50cm 48 - 58cm 53 - 63cm 58 - 68cm
How to measure
NOTE: Measure length along the lateral outer arm from the wrist to the axilla with a slight bend in the arm.
C GWrist Elbow Axilla
Small 14cm - 18cm 20cm - 27cm 22cm - 31cm
Medium 16cm - 21cm 25cm - 34cm 29cm - 39cm
Large 19cm - 25cm 30cm - 40cm 32cm - 45cm
Length
Short 40cm - 43cm
Regular 44cm - 47cm
Long 48cm - 51cm
JOBST® FarrowWrap® RTW Armsleeve size chart
JOBST® FarrowWrap® RTW Gauntlet sizing chart
Xsmall Small Medium Large
A 16cm - 18cm 18cm - 20cm 20cm - 22cm 22cm - 24cm
B 17cm - 19cm 19cm - 21cm 21cm - 23cm 23cm - 26cm
C 15cm - 18cm 17cm - 20cm 19cm - 22cm 22cm - 24cm
JOBST® FarrowWrap® Liner sizing chart
Terry Cloth Liners Can accommodate the following calf circumferences:
Small (>40 cm), Medium (40-70 cm) and Large (70-120 cm).
Silver LinersSmall – Can accommodate calf circumferences to 60cm.
Large – Can accommodate calf circumferences to 70cm.
Hybrid LinersMeasure the mid foot A circumference.
Two mid foot sizes available: 20-27cm (regular foot) and 28-35cm (wide foot).
Request the patients shoe size (US Sizing).
Jobst® FarrowWrap® Knee piece sizing chart
Male Shoe Size
Female Shoe Size
Small 3 – 6 4 – 7
Medium 7 – 9 8 – 10
Large 10 – 12 11 – 13
XLarge 13 – 15 14 – 16
Note the maximum calf size for Hybrid Liners is 60cm
your care
Supporting
journey
JOBST® FarrowWrap® Ordering FormDoctor/Nurse/Clinician’s name: Phone:
Client’s name: Phone:
Client’s address:
Order No.: Date:
Style Fabric Size Ordering Code Quantity
Hybrid LinerCompression in the foot only
☐ ADI (20-30mmHg)
☐ ADII (30-40mmHg)
☐ Small☐ Medium☐ Large☐ XLarge
☐ Regular Foot
☐ Wide Foot
Footpiece(Fits midfoot 22-40cm circumference)
☐ LITE (20-30mmHg)
☐ STRONG (30-40mmHg)
☐ CLASSIC (30-40mmHg)
☐ Xsmall☐ Small☐ Medium☐ Large☐ XLarge
☐ Regular
☐ Long
Legpiece(Fits 36-68cm circumference, 35-51cm length)
☐ LITE (20-30mmHg)
☐ STRONG (30-40mmHg)
☐ CLASSIC (30-40mmHg)
☐ Xsmall☐ Small☐ Medium☐ Large☐ XLarge
☐ Regular
☐ Tall
Kneepiece☐ LITE (20-30mmHg)
☐ STRONG (30-40mmHg)
☐ Xsmall☐ Small☐ Medium☐ Large☐ XLarge
Thighpiece (Comes with knee piece)
☐ LITE (20-30mmHg)
☐ STRONG (30-40mmHg)
☐ CLASSIC (30-40mmHg)
☐ Xsmall☐ Small☐ Medium☐ Large☐ XLarge
☐ Short
☐ Regular
☐ Tall
Armsleeve
☐ LITE (20-30mmHg)
☐ Left ☐ Right
☐ Black ☐ Beige
☐ Small☐ Medium☐ Large
☐ Short
☐ Regular
☐ Long
Farrow Toe Cap/Glove
(20-30mmHg)
☐ Xsmall☐ Small☐ Medium☐ Large
Gauntlet ☐ LITE (20-30mmHg)
☐ Xsmall☐ Small☐ Medium☐ Large
Liner options
When a foot piece and leg piece are purchased together one pair of AD liners are supplied free. Please state preference:
☐ Silver (closed toe) Size ☐ Small ☐ Large ☐ Soft (open toe) Size ☐ Small ☐ Medium ☐ Large When a foot piece, leg piece and thigh piece are purchased together one pair of AG liners are supplied free. Please state preference:
☐ Soft (open toe) Size ☐ Small ☐ Medium ☐ Large
Left Right Size
Legpiece
Calf
Ankle
Length
Footpiece
Mid foot
Length
Thighpiece
Groin
Above Knee
Length
Kneepiece
Above knee
Calf
Left Right Size
Armsleeve
Wrist
Elbow
Axilla
Length
Gauntlet
Palm A
Palm B
Wrist C
Toe Cap/ Glove
Metatarsal Heads A
JOBST® FarrowWrap® Measurement Record
Local JOBST StockistESS0025 03/2019
BSN medical Australia & New Zealand an Essity company
L6, 211 Wellington Road, Mulgrave, Victoria Australia 3170PO Box 337, Mount Waverley, Victoria 3149
JOBST® Customer Service AustraliaT 1300 998 810 F 1300 998 820 www.bsnmedical.com.auJOBST® Customer Service New ZealandT 0508 998 810 F 0508 998 820www.bsnmedical.co.nz
cA-Circumference (cm)
