Order Forms

Single Position Standers
HCPCS: E0638

Supine – size 1 – ITEMIZED
Supine – size 2 – ITEMIZED
Supine TT – size 1 – ITEMIZED
Supine TT – size 2 – ITEMIZED
Prone – size 1 – ITEMIZED
Prone – size 1 – PACKAGE
Prone – size 2 – ITEMIZED
Prone – size 2 – PACKAGE

Multi-Position Standers
HCPCS: E0641

MPS – size 1 – ITEMIZED
MPS – size 1 – PACKAGE
MPS – size 2 – ITEMIZED
MPS – size 2 – PACKAGE
MPS TT – size 1 – ITEMIZED
MPS TT – size 1 – PACKAGE
MPS TT – size 2 – ITEMIZED
MPS TT – size 2 – PACKAGE

MPS Portable – size 1 – ITEMIZED
MPS Portable – size 1 – PACKAGE
Supine Portable – size 1 – ITEMIZED
Prone Portable – size 1 – ITEMIZED