HANDS
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for professionals
“One package goes all the way”
Global Online Ordering System
Name patient
dd/mm/yyyy
Date of Birth
Gender
m
. . /. . / . . . .
Measured by
Signature
Date of Measuring
. . / . . / 201 .
f
Contact Person
Department
Circumference
w3
Length
w4
w2
y3
y2
y4
w5
w1
y5
x5
AB
y1
A
x4
B
x3
AC
x1
x2
C
CD
D
UP
PALM
CO01
skin/skin
CO02
skin/black
CO03
SI01
black/black
skin
COMFORT
SILICONE
ST01
skin/skin
ST03
ST06
black/black
ST08
blue/black
green/black
ST09
ST10
red/skin
red/black
STRONG
ST11
ST14
pink/skin
bordeaux/black
ST16
grey/black
ST17
light grey/skin
ST18
light grey/black
ST19
navy blue/skin
ST20
navy blue/black
STRONG
Options:
y1: ......
F0066-2.17-en
closed fingers
half glove
closed thumb
open fingers
(min. length 1.5cm)
halve glove
open thumb
symbol boy
wrist without pressure
symbol girl
with zipper (always on back)
Remarks:
y2: ......
…………………………………………………
y3: ......
…………………………………………………
y4: ......
…………………………………………………
y5: ......
…………………………………………………
glove + arm sleeve in 1 piece
left hand
right hand
nv Tricolast sa - Kortijkstraat 52 - B-9800 Deinze|www.caroskin.eu - [email protected]|GOOSe Online: Free|T + 32(9) 386 15 11 - F + 32(9) 386 16 09 (10€/Fax)