Charge /inventory Control Sheet - Shoulder Options
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1Charge /Inventory Control Sheet
Shoulder Options, Inc.
Customer Service Dept.
100 E. South Main St.
P.O. Box 1458
Waxhaw, NC 28173
TM
Fax : (208) 246-1466
AFT Proximal Humerus Fracture Plate
Phone : (704) 512-0000
Customer #
PO Number
Reference P.O Only
Hospital
Street
Surgery Date
City
State
Zip
Physician
Need by Date
Patient ID
Prepared by (name and phone)
Case/Tray Number
Fracture Plate Implants: (mark quantity to be replaced)
Fracture Plate Implants: (continued)
Unit Price
Qty
Unit Price
Qty
________
______ SO02-3000
Long Fracture Plate, Left
________
______ SO02-3008-42.5 4.5 Locking Screw, 42.5mm
________
______ SO02-3001
Long Fracture Plate, Right
________
______ SO02-3008-45
4.5 Locking Screw, 45mm
________
______ SO02-3002
Short Fracture Plate, Left
________
______ SO02-3008-47.5 4.5 Locking Screw, 47.5mm
________
______ SO02-3003
Short Fracture Plate, Right
________
______ SO02-3008-50
4.5 Locking Screw, 50mm
________
______ SO02-3005-30
4.5 Malleolar Screw, 30mm
________
______ SO02-3008-52.5 4.5 Locking Screw, 52.5mm
________
______ SO02-3005-32.5 4.5 Malleolar Screw, 32.5mm
________
______ SO02-3008-55
4.5 Locking Screw, 55mm
________
______ SO02-3005-35
4.5 Malleolar Screw, 35mm
________
______ SO02-3005-37.5 4.5 Malleolar Screw, 37.5mm
As Needed: Instruments (mark quantity to be replaced)
________
______ SO02-3005-40
4.5 Malleolar Screw, 40mm
________
______ SO02-3005-42.5 4.5 Malleolar Screw, 42.5mm
Unit Price
Qty
________
______ SO02-3005-45
4.5 Malleolar Screw, 45mm
________
______ SO02-3050 Long Drill Guide Plate, Left
________
______ SO02-3005-47.5 4.5 Malleolar Screw, 47.5mm
________
______ SO02-3051 Long Drill Guide Plate, Right
________
______ SO02-3005-50
4.5 Malleolar Screw, 50mm
________
______ SO02-3052 Short Drill Guide Plate, Left
________
______ SO02-3005-52.5 4.5 Malleolar Screw, 52.5mm
________
______ SO02-3053 Short Drill Guide Plate, Right
________
______ SO02-3005-55
4.5 Malleolar Screw, 55mm
________
______ SO02-3054 Proximal Depth Gauge
________
______ SO02-3006-20
3.5 Locking Screw, 20mm
________
______ SO02-3065 Distal Depth Gauge
________
______ SO02-3006-22.5 3.5 Locking Screw, 22.5mm
________
______ SO02-3060 2.7 mm Drill Guide
________
______ SO02-3006-25
3.5 Locking Screw, 25mm
________
______ SO02-3061 3.0 mm Drill Guide, Short
________
______ SO02-3006-27.5 3.5 Locking Screw, 27.5mm
________
______ SO02-3062 3.7mm Drill Guide
________
______ SO02-3006-30
3.5 Locking Screw, 30mm
________
______ SO02-3063 3.0 mm Drill Guide, Long
________
______ SO02-3006-32.5 3.5 Locking Screw, 32.5mm
________
______ SO02-3070 2.5mm Hex Screwdriver
________
______ SO02-3006-35
3.5 Locking Screw, 35mm
________
______ SO02-3075 3.5mm Hex Screwdriver
________
______ SO02-3006-37.5 3.5 Locking Screw, 37.5mm
________
______ SO02-3077 2.5mm Hex Screwdriver Bit
________
______ SO02-3006-40
3.5 Locking Screw, 40mm
w/ Spring Tip
________
______ SO02-3006-42.5 3.5 Locking Screw, 42.5mm
________
______ SO02-3078 3.5mm Hex Screwdriver Bit
________
______ SO02-3006-45
3.5 Locking Screw, 45mm
w/ Spring Tip
________
______ SO02-3006-47.5 3.5 Locking Screw, 47.5mm
________
______ SO02-3080 Fracture Reduction Forceps
________
______ SO02-3006-50
3.5 Locking Screw, 50mm
(Verbugge)
________
______ SO02-3006-52.5 3.5 Locking Screw, 52.5mm
________
______ SO02-3085 Fracture Reduction Forceps
________
______ SO02-3006-55
3.5 Locking Screw, 55mm
________
______ SO02-3081 4.5mm QC/AO Ratcheting
________
______ SO02-3007-20
3.5 Non-Locking Screw, 20mm
Handle
________
______ SO02-3007-22.5 3.5 Non-Locking Screw, 22.5mm
________
______ SO02-3007-25
3.5 Non-Locking Screw, 25mm
Disposable: Instruments (mark quantity to be replaced)
________
______ SO02-3007-27.5 3.5 Non-Locking Screw, 27.5mm
________
______ SO02-3007-30
3.5 Non-Locking Screw, 30mm
Unit Price
Qty
________
______ SO02-3007-32.5 3.5 Non-Locking Screw, 32.5mm
________
______ SO02-3007-35
3.5 Non-Locking Screw, 35mm
________
______ SO02-3066 2.7 mm Drill Bit
________
______ SO02-3067 3.0 mm Drill Bit
________
______ SO02-3007-37.5 3.5 Non-Locking Screw, 37.5mm
________
______ SO02-3068 3.7 mm Drill Bit
________
______ SO02-3007-40
3.5 Non-Locking Screw, 40mm
________
______ 16-IN-KW150 1.6x150 mm K-wires,
________
______ SO02-3007-42.5 3.5 Non-Locking Screw, 42.5mm
trocar tip
________
______ SO02-3007-45
3.5 Non-Locking Screw, 45mm
________
______ SO02-3008-30
4.5 Locking Screw, 30mm
________
______ SO02-3008-32.5 4.5 Locking Screw, 32.5mm
________
______ SO02-3008-35
4.5 Locking Screw, 35mm
Total Price ________________________________________
________
______ SO02-3008-37.5 4.5 Locking Screw, 37.5mm
Please fax completed forms to
Shoulder Options Customer Service at
Place Patient Sticker Here
(208) 246-1466
Document # 10510 Rev B
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