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RMS AFO
RMS AFO
TEST WOO-Full - RMS AFO
Clinic
Clinician
Patient ID
Order Reference
Rectified by clinician
Standard RMS
Include production model
Side
Left
Right
Function
Dropfoot prevention
Varus/valgus stability
Weight (kg)
Activity Level
K4
Tongue
Standard
Wide
Reliefs/Buildup
Malleoli Medial
Malleoli Lateral
Malleoli Lateral
Flare proximal edges
Heel height
10mm
Other
Other
mm
Shank angle
No change
Neutral
Other
Other
Degrees
Correct heel
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