GLOVE
Patient name
DOB
Sex
Contact
Customer code
Date
Measured by
Signature
Male
Female
w3
w4
w2
y3
y2
y4
w5
w1
y5
x5
AB
y1
x4
x3
AC
x1
A
B
x2
C
Circumference
CD
Length
D
PALM
pen Finger
O
(minimum
length 1.5cm)
Special requirements
DISTRIBUTED BY
Medical Accessories of Australia
TOP
alf Glove
H
Open Thumb
Comfort
Strong
Class
C001 Beige
C003 Black
ST01 Beige
ST03 Black
Class I
Class II
Class III
Options
rist without pressure
W
Glove and sleeve in one piece
Left glove
Right glove
11/43 Lang Parade, Milton Q 4064 | P. 1300 527 127 | F. 07 3870 5944
E. [email protected] | W. www.medicalaccessories.com.au