Retail Pharmacy LTC Pharmacy Hours 2330 Yew Street 1414 Meador Avenue, H-102 Mon-Fri 9:00am - 6:00pm Bellingham, WA 98229 Bellingham, WA 98229 Saturday 9:00am - 5:00pm Phone:(360) 685-5004 Phone: (360) 734-7544 Sunday - Closed Fax:(360) 685-5055 Fax: (360) 734-7547 www.hoaglandpharmacy.com Medical Compression Hosiery/Stockings Fitting and Measuring Guide
Patient Name: Date:
Address: City: State: ZIP:
Patient Phone: D.O.B. Height: Weight:
Primary Insurance: ICD-9 Diagnosis:
Physician Name: Physician Phone:
Check one (1) box in each category for Compression Stocking preferences.
Style of Stocking Compression Brand Preference Quantity
Thigh 15-20 mmHg Jobst 1 Pair Calf 20-30 mmHg Medi 2 Pairs Panty 30-40 mmHg Sigvaris 3 Pairs Maternity 40-50 mmHg Other: 4 Pairs
50-60 mmHg ______
PATIENT INSTRUCTIONS: IMPORTANT: - Prescriptions should indicate: - No appointment is necessary. (a) Compression Level (20-30 mmHg, 30-40 mmHg, etc.) - Bring this prescription to Hoagland Pharmacy at (b) Length of Stocking (below knee, thigh length, panty hose, etc.) 2330 Yew Street and we will fit you with hose (c) Any additional pertinent information (diagnosis, etc.) - Before fitting client, remove any jewelry that might snag the stocking and cause a run. - This must be done between 9am and 11am Mon-Fri - Long fingernails might snag the stocking as well. - Please check with your insurance for coverage - Using thick rubber gloves will ease the application of the stocking. - Any Questions? Call Customer Service at (360) 685-5004 - If swelling/edema is an issue, take measurements first thing in the morning, within one (1) hour of rising. Measure at the points listed beneath the style you selected. Measure in INCHES. Calf Style Thigh Style Panty Style
Left Ankle Right Ankle Left Ankle Right Ankle Left Ankle Right Ankle
Left Calf Right Calf Left Calf Right Calf Left Calf Right Calf
Length from Calf to Heel Left Thigh Right Thigh Left Thigh Right Thigh
Length from Thigh to Heel Hips
Length from Thigh to Heel
NOTES:
Physician Signature: Patient Signature: (Substitution Permitted) TO APPLY THE STOCKINGS: (Self application shown, but principles are the same:)
1. Place your hand inside the 2. Using both hands, place two 3. Continue pulling the stocking stocking and grasp the heel pocket. fingers inside the stocking on each over the foot until the heel pocket Pull the stocking "inside out", up side of the heel, pulling out on is positioned evenly over the foot. to the heel. each side with equal force. Begin Begin turning the stocking "right to gently slide the stocking over side out" to ensure proper the toes and foot. placement on the foot.
4. After the stocking is turned right 5. Remove any folds by gently 6. The stocking is correctly applied side out, use the thumb and pulling upwards; use both hands to when the heel pocket is centered forefinger to position the rest of remove any remaining wrinkles. directly over the heel and the the stocking over the leg, pulling it (Be careful not to stretch the stocking is smooth and uniform in up in small increments, smoothing stocking too much; just eliminate appearance throughout its entire it as you go. the wrinkles.) length. Below knee stockings will end about 2 finger widths below you knee cap, thigh high stockings will end about mid-thigh and panty TO REMOVE THE STOCKINGS: hose will end just over the hips.
1. Grasp the top of the stocking 2. Insert a finger between the 3. Slowly pull the foot of the and begin turning it inside out; stocking and the leg, and gently stocking off the foot. gently pull down to the ankle. pull the stocking over the ankle.
TO LAUNDER THE STOCKINGS: To obtain months of comfortable wear, wash gently in lukewarm or cold water with a mild soap or detergent. Rinse untill the water is clear. Do not wring out or twist. Roll in a soft, absorbant towel to remove excess water, then air-dry flat. Do not hang the stocking vertically; this will cause it to strech out. Keep stockings out of contact with oils, petroleum based ointments, Woolite and direct sunlight.