Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Client Services 1-800-263-8700 • Adult: [email protected] • Pediatric: [email protected] • www.oticon.ca
RITE Mold Colour
RITE Options
miniFit Receivers L R 0 1 2 3 4 5
miniFIT 60
miniFIT 85
miniFIT 100 n/a
designRITE 80 n/a
100/105 power mold n/a
DomesSize in mm:
5* 6 8 10 12Open n/a
Bass single n/a
Bass double n/a
Power n/a
Corda miniFit Domes
Size in mm:6 8 10 12
Open n/a
Bass single
Bass double
Power
Grip TipL R
Small Large
Vent No vent
RITE Molds Acrylic Silicone
Micromold LiteTip In-Mold Microshell RITE Power Micromold RITE Power
60 60 60 60 100 60 100
85 85 85 85 105 85
80 80 100 80
80
L R
Micromold n/a n/a
Canal* n/a n/a n/a
Canal Lock n/a
Half Shell n/a n/a n/a
Semi Skeleton n/a n/a n/a n/a
Skeleton n/a
Shell n/a n/a n/a
Non-occluding 100/105 receivers cannot be used for non-occluding
Canal Lip* Removal Line
Vent Size: 0.8 1.4 2.4 3.0 No Vent
LiteTip Vent Size 0.7 0.8 1.2 1.5 No Vent
BTE Molds Acrylic Silicone Soft Silicone
L RBTE
Corda miniFit
micromold
Corda miniFit
LiteTipBTE Corda
miniFit BTE
Micromold n/a n/a n/a
Canal
Canal Lock
Half Shell n/a
Semi Skeleton n/a n/a n/a n/a
Skeleton
Non-occluding n/a n/a n/a n/a
Shell n/a
Full Mold n/a
If pre-programming is selected, both audiometric & patient information must be provided in full. Otherwise aid will be shipped at factory settings.
Special Instructions
Earmold Tubing L R
#13 Thin Wall
#13 Standard
#13 Heavy
#13 Super Heavy
#13 Dri
#13 Heavy Dri
Corda miniFit
Tubing Length L R
-1
0
1
2
3
4
Shell __________(See reverse for options)
Faceplate __________(If applicable.)
BTE Mold Colour ____________________________________(See reverse for options)
*5mm for 60 receiver only
Corda miniFit size L R Vent size: 0.8 1.4 1.8 2.4 3.0 No vent
Standard 0.9 mm LiteTip Vent size: 0.7 0.8 1.2 1.5 No vent
Power 1.3 mm* * Not applicable with LiteTip Removal Line
Streamer & ConnectLine Products *Requires a Streamer
Streamer Pro ConnectLine TV 2.0* ConnectLine Microphone*White Black ConnectLine Phone 2.0* Remote Control
Velox Accessories *Devices not backwards compatible
Remote Control 3.0* TV Adapter 3.0* ConnectClip* Phone 2.0
Velox S Charger (miniRITE-R only)
MIS
C-O-
010
/ 02.
19
Choose your RITE or BTE Style: Please check box A or B below
A) I do not need to order the instrument(s) but, I will be fitting the earpiece to: Choose make and model: __________________________________ Indicate attached receivers: ____________________________________
B) I wish to order earpiece AND instrument(s), please include: Choose make and model: L ____________________ R ____________________ Colour: L _______________ R _______________(See reverse for options) (See reverse for options)
Date Order Placed: _ /_ /_
Bill to Account # ___________________________
Name: ______________________________________
Address: ____________________________________
Phone: _____________________________________
Ship to Account # _________________________
Name: ______________________________________
Address: ____________________________________
Phone: _____________________________________
RITE & BTE Earmold Order Form
V012
Patient Information:Name: ______________________________________
Pediatric Date of Birth: _ /_ /_ D D M M Y Y Y Y
Clinician Contact Date Required
Claim # (CSST, DVA, NIHB, WCB, WSIB) Purchase Order #
Please do not write in this space. For manufacturer use only.
Priority Rush: 1 Business Day (in house) $30 Rush: 2 Business Days (in house) $20
Standard delivery is 5 business days at no charge
Please pre-program Please return impressions
RITE and BTE Styles
Inium Sense
designRITE miniRITE RITE miniBTE BTE BTE P PP SP
Alta2 Pro ● ● Ti ● Ti ● ● Ti ● ● n/a
Alta2 n/a ● ● ● ● ● ● n/a
Nera2 Pro ● ● Ti ● Ti ● ● Ti ● ● n/a
Nera2 n/a ● ● ● ● ● ● n/a
Ria2 Pro ● ● Ti ● Ti ● ● Ti ● ● n/a
Ria2 n/a ● ● ● ● ● ● n/a
Dynamo n/a n/a n/a n/a n/a n/a n/a ●
Sensei Pro SP n/a n/a n/a n/a n/a n/a n/a ●
Sensei SP n/a n/a n/a n/a n/a n/a n/a ●
Velox S
miniRITE miniRITE-T miniRITE R BTE PP
Opn S1 ● ● ● ●
Opn S2 ● ● ● ●
Opn S3 ● ● ● ●
Opn Play 1 ● ● ● ●
Opn Play 2 ● ● ● ●
Rise 2
BTE /SP
Sumo DM (675) ●INIUM
WIRELESS
INIUMWIRELESS
Velox
miniRITE miniRITE-T BTE BTE PP
Opn 1 ● ● n/a ●
Opn 2 ● ● n/a ●
Opn 3 ● ● n/a ●
Siya 1 ● ● ● ●
Siya 2 ● ● ● ●
Write your choice on the reverse side
RITE and BTE Colours BTE Earmold Colours Write your choice on the reverse side
Write your choice on the reverse side
All Models miniRITE designRITE Only
Alta2Nera2Ria2
Dynamo
63 Diamond Black92 Steel Grey91 Silver Grey44 Silver90 Chroma Beige94 Terracotta93 Chestnut Brown
47 Cool Blue 95 Vivid Lilac66 Mother of Pearl73 Cabernet Red68 Midnight Blue69 Sunset Orange99 Pale Lime
Opn PlaySensei SP
63 Diamond Black94 Terracotta90 Chroma Beige44 Silver70 Purple
46 Red47 Blue 48 Emerald Green93 Chestnut Brown
57 Power Pink 58 Aquamarine 79 Baby Pink
Classic Colours
Sumo DM
10 Beige11 Light Brown12 Dark Brown
13 Light Gray14 Dark Gray
All Models
Opn S Opn Siya
CO90 Chroma BeigeCO94 Terracotta ▲
CO93 Chestnut BrownCO63 Diamond BlackCO92 Steel Grey
CO68 Royal Blue*▲
CO91 Silver GreyCO44 Silver▲
RITE Molds - Acrylic Colour Selection
Micromold Clear
LiteTip Clear
InMold Shell: Beige (Std), Clear, Red, Blue
Faceplate: Beige (Std), Pink, Med Brown, Dark Brown, Clear
Microshell Shell: Beige (Std), Clear, Red, Blue
RITE Pwr - 100/105 Canal Style: Beige (Std), Clear, Red, BlueOther Styles: Clear (Std), Beige, Red, Blue
RITE Molds - Silicone Colour Selection
Clear
BTE Molds - Acrylic Colour Selection
Clear
BTE Molds - Silicone Colour Selection
Clear, Beige, Green, Blue, Med Brown, Dark Brown, Yellow, White, Red, Lilac, Black, Orange, Flesh Tone, Fluorescent Pink*
*Opn miniRITE only ▲ Not available for Siya
MISC-O-010 / 02.19
*Soft Silicone Only