Made to measure order form
Round knit . Fax 01432 373510
From:
medi UK Ltd.
Plough Lane
Hereford HR4 OEL
Great Britain
Tel. 01432 373500
Fax 01432 373510
[email protected]
www.mediuk.co.uk
Order Ref No:
male
Stamp/Signature
female
Patients Name:
Measured by:
Contact Tel. No.:
Date:e-mail:
l K 1T
Please complete part A & B if panty section required. All measurements must follow contours of body.
lef t patients leg/cm
cB1
cB
cY
cA
cT
lH
cH
cT
cK
lG
cG
lF
cF
lE
cE
lD
cD
lC
cC
l B1
lB
Waist
c B1
cB
Hips
lH
lK
lG
lE
lD
lC
c B1
cB
cY
cA
l B1
lB
Left leg
cY
cA
lA
lA
lZ
lZ
Styles
(AD) (AT)
(AG)
(ATE)
cm short
not available in mediven elegance
men s̓ one legged panty
(standard fly)
capri shorts
leggings
men s̓ panty (standard fly)
maternity panty
cycling shorts
Foot length to heel
l K 2T = Measure from
gluteal fold to panty top
lK T
l K 1T
l K 21T
Bl K
l K2
cT
lT
cH
lH
l K1
l K 2T
l K1
cG
lG
l K 1 = Measure
lfrom
K 2 groin to floor
cF
lF
cE
lE
cD
lD
cC
lC
c B1
l B1
cB
lB
K
cY
cA
Foot lengths
l K 2T
l K 2T
T
l K2
K2
1
l K1
lCrease
K 2 = Measure
l from
gluteal
to floor
offoldknee
l K2
left
right
Quality CCL
mediven plus 1, 2, 3
mediven elegance 1 & 2
mediven forte 2, 3
Quantity
pieces
Compression CCL 1 CCL 2 CCL 3
lA
lA
lZ
lZ
Colours below knee pantyhose
thigh length
one-legged panty
G–F/E
leg
section
T
l K 1T
l K 1T = Measure from
groin to panty top
cK
lF
cE
cD
cC
Length
from floor up
lT
cH
cK
cG
cF
Right leg
cE
cD
cC
lT
Left leg
cH
cK
cG
cF
mediven® compression garments leg round-knitted
cT
A
CircumferenceCircumference
from floor up
Right leg
Length
right patients leg/cm
panty section
left leg
right leg
Gusset
mediven plus
Beige
Black
Caramel
mediven elegance
Beige
Sand
Navy
Trend
colour:
Black
Siena
Diamant
Caramel
White
Montana
mediven forte
Caramel
Black
tricot is standard
netting
wide
compressive
cm
Special requests
Attachment
silicone topband on mediven forte only available in 5 cms width
waist attachment not available in mediven elegance
silicone topband narrow (2.5 cm)
broad (5 cm)
below knee only
sensitive silicone topband (5 cm)
lace topband (5 cm)
Closed toe
lZ
cm (total size)
lA
cm (straight foot)
medi is not responsible for incorrect measurements. medi assumes
no liability as a result of any contraindicated use of this product.
99391_PMSO_210x297_Maßblock_A4_Orderform_RoundKnit_Leg_UK_08_2014.indd 1
medi. I feel better.
99391/07.2014
Open toe
30.07.14 13:28