Compression Stockings Measuring Guide - …

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Compression Stockings Measuring GuidePatient Name: ________________________________________ ____ Date: __________________________Patient Phone:__________________________________ __________ DOB:__________________________Physician Name (printed): __________________________________ Physician Ph: ____________________Stocking Style:oKnee HighoThigh HighoPantyhoseoSocksMeasurements:Measure ments should be taken first thing in the morning when the legs are the least measurements for theselected style at the points listed below. Measure in inches at the widest High / Socks______Right Ankle (b)______Left Ankle (b)______Right Calf (c)______Left Calf (c)______Length (1)______Shoe SizeThigh High______RightAnkle (b)______Left Ankle (b)______Right Calf (c)______Left Calf (c)______Right Thigh (f)______Left Thigh (f)______Length (2)Pantyhose______Right Ankle (b)______Left Ankle (b)______Right Calf (c)______Left Calf (c)______Right Thigh (f)______Left Thigh (f)______Right Upper Thigh (g)______Left Upper Thigh (g)______Waist (h)Graduated Therapy:20-30 mm Hg H31xy, H32xy, H33xySIZEAnkle (b)Calf (c)MId Thigh (f) Upper Thigh (g)S61 4- 71 4"11 - 13 1 2"15 - 19"16 - 20 1 2"M71 2- 9"13 - 15 1 2"18 1 2- 22"20 - 24 1 2"L91 4- 10 3 4"15 - 17 1 2"21 1 2- 25"24

Compression Stockings Measuring Guide Patient Name:_____ Date: _____ Patient Phone:_____ DOB:_____

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