When mild control is needed for medial/ lateral instability. This functionally efficient completely custom AFO offers split uprights, mechanical ankle axis. EVA topcover, balanced footplate, low-profile trimlines. Removable interface pads are designed to be washable and add needed comfort. Requires mid-calf cast. When moderate control is needed for medial/ lateral instability. Custom AFO with balanced footplates, mechanical ankle axis and custom uprights that connect to posterior bar adding more stability and control. Removable interface pads are designed to be washable and add needed comfort. Requires mid-calf cast. When moderate cotrol is needed for medial/ lateral instability. With the added feature of Tamarack dorsi-assist ankle joints. Designed for patients with drop foot during the swing phase of gait. Removable interface pads are designed to be washable and add needed comfor t. Requires mid-calf cast. Free Motion Split Upright Free Motion Solid Upright Dorsi-Assist Solid Upright ORDER INFORMATION Customer Information Date Company Contact Person Phone Ship Via/Shipping Instructions Date Required Protected Health Information Patient Name/ID Custom Fabrication Hotline 877-737-8444 Fax 877-737-8445 | orthomerica.com/spectrum 6333 N Orange Blossom Trl, Orlando FL 32810 © 2014 Orthomerica Products, Inc. All Rights Reserved. 505-0000-160 Rev. D

All information must be completed or your order will be put on hold. Unspecified options will default to those in bold. Items marked with * will incur additional charges. MID-CALF DESIGN  Spectrum 100   Spectrum 300   Color  Black  Crepe Heel Post  None   Heel Only  Side  Left  Free Motion Free Motion Dorsi-Assist Split Upright Solid Upright Solid Upright Finished Heel Post Position Crepe Forefoot Post Position  None  Foot Plate Liner Options  Standard (EVA)  Foot Plate Pastic Length  To Mets   Bi-laminate Poron Pastazote* Foot Plate Liner Length  To Sulcus  Heel Cup Height  35mm (1 3/8”) Standard ...