Form 5 LC-500 Gauntlet with thumb LC-500.1 Elbow-length gauntlet with thumb I II In case of gauntlet with full sleeve, please mark your preference: Hand Please add to Form 5 the corresponding form for the full sleeve. 7-A 7-B 7-C 7-D Measurements should be taken first thing in the morning. Measurements should be taken with a metric tape-measure taking care to complete them all. F5 - ENG Revisión: 1 Fecha: 01/10/2009
Form 6-A LC-501 Glove with fingers to the nail LC-501.1 Elbow-length glove with fingers to the nail I II In case of glove with full sleeve, please mark your preference: Hand Please add to Form 6-A the corresponding form for the full sleeve. 7-A 7-B 7-C 7-D Measurements should be taken first thing in the morning. Measurements should be taken with a metric tape-measure taking care to complete them all. F6A - ENG Revisión: 1 Fecha: 01/10/2009
Form 6-B LC-502 Glove with fingers to the knuckle LC-502.1 Elbow-length glove with fingers to the knuckle I II In case of glove with full sleeve, please mark your preference: Hand Please add to Form 6-B the corresponding form for the full sleeve. 7-A 7-B 7-C 7-D Measurements should be taken first thing in the morning. Measurements should be taken with a metric tape-measure taking care to complete them all. F6B - ENG Revisión: 1 Fecha: 01/10/2009
Form 7-A LC-503 Sleeve with stay-up silicon strip LC-503.1 Sleeve with stay-up silicon strip, with gauntlet LC-503.2 Sleeve with stay-up silicon strip and glove with short fingers LC-503.2L Sleeve with stay-up silicon strip and glove with long fingers I II In case of glove or gauntlet with sleeve, please mark your preference: Arm Please add to Form 7-A the corresponding form for the glove or gauntlet. 5 6-A 6-B Measurements should be taken first thing in the morning. Measurements should be taken with a metric tape-measure taking care to complete them all. F7A - ENG Revisión: 1 Fecha: 01/10/2009
Form 7-B LC-504 Sleeve with shoulder and narrow supporting strap LC-504.1 Sleeve with shoulder and narrow supporting strap, with gauntlet LC-504.2 Sleeve with shoulder and narrow supporting strap and glove with short fingers LC-504.2L Sleeve with shoulder and narrow supporting strap and glove with long fingers I II In case of glove or gauntlet with sleeve, please mark your preference: Arm Please add to Form 7-B the corresponding form for the glove or gauntlet. 5 6-A 6-B Measurements should be taken first thing in the morning. Measurements should be taken with a metric tape-measure taking care to complete them all. F7B - ENG Revisión: 1 Fecha: 01/10/2009
Form 7-C LC-505 Sleeve with shoulder and wide supporting strap LC-505.1 Sleeve with shoulder and wide supporting strap, with gauntlet LC-505.2 Sleeve with shoulder and wide supporting strap and glove with short fingers LC-505.2L Sleeve with shoulder and wide supporting strap and glove with long fingers I II In case of glove or gauntlet with sleeve, please mark your preference: Arm Please add to Form 7-C the corresponding form for the glove or gauntlet. 5 6-A 6-B Measurements should be taken first thing in the morning. Measurements should be taken with a metric tape-measure taking care to complete them all. F7C - ENG Revisión: 1 Fecha: 01/10/2009
Form 7-D LC-506 Sleeve with shoulder attached to bra strap LC-506.1 Sleeve with shoulder attached to bra strap, with gauntlet LC-506.2 Sleeve with shoulder attached to bra strap and glove with short fingers LC-506.2L Sleeve with shoulder attached to bra strap and glove with long fingers I II In case of glove or gauntlet with sleeve, please mark your preference: Arm Please add to Form 7-D the corresponding form for the glove or gauntlet. 5 6-A 6-B Measurements should be taken first thing in the morning. Measurements should be taken with a metric tape-measure taking care to complete them all. F7D - ENG Revisión: 1 Fecha: 01/10/2009
Form 8 LC-508 Below-knee stocking LC-509 One-leg stocking with hip support LC-510 Full trousers LC-510-E Full trousers of two separate stockings LC-513 Thigh-length stocking I II III Crotch Toe Open open closed Closed open closed Measurements should be taken first thing in the morning. Measurements should be taken with a metric tape-measure taking care to complete them all. F8 - ENG Revisión: 2 Fecha: 01/01/2011
Form 9 LC-507 Foot glove LC-507.1 Foot glove with heel fastening I II Foot Measurements should be taken first thing in the morning. Measurements should be taken with a metric tape-measure taking care to complete them all. F9 - ENG Revisión: 1 Fecha: 01/10/2009
Form 11 LC-511 Bra Beige White Black LC-512 Bra-vest Beige White Black Inside prosthesis pocket I Neck V-neck Round neck II III Chest With neither breast Without right breast Without left breast Size Indicate your bra and cup size Size... Cup A B C D NOTE Model LC-512 can be made to the length needed. Measurements should be taken first thing in the morning. Measurements should be taken with a metric tape-measure taking care to complete them all. F11 - ENG Revisión: 1 Fecha: 01/10/2009