Black -01 Moss green -95 Yellow -99. Heather purple -97. Indicate height. Indicate height. Indicate angle. Indicate height: cm. Indicate height: cm

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1 Cross 5 XL Prescription form 75188K Reference: Name: Tel: Date: version is marked with The measurements given can vary ±% Short frame Seat width (cm) Seat depth 36-4 (-49*)cm Measured from back post (*Triangular back support) Long frame Seat width (cm) Seat depth 4-48 (-55*)cm Measured from back post (*Triangular back support) 47, , , , , , Black -01 Moss green -95 Yellow -99 Frame colour Cross back 3A Dark blue -93 Coral -96 Pearl grey -94 Heather purple -97 Type Lumbar angle standard +7 Triangular Back Support Height 3-45 cm (std 40 cm) height cm Lumbar angle Back Support Height High cm (std 46 cm) height cm Back Support Angle (std + ) angle angle Cover Comfort Tidy Cross back Cross back, widened Continuosly adjustable cm. 35 cm Continuosly adjustable cm. 35 cm Extends the width 5 cm height: cm height: cm Cover standard Cover comfort tubes for hard shell back support, ECS tubes for hard shell widened back support, ECS (max chair width 55 cm) angle Push handles Push handles Detachable, height adjustable Continuosly adjustable cm 35 cm Continuosly adjustable 37-4 cm 37 cm Extends the back support width by 5 cm + = 9 between back and seat Bow handle Detachable, height adjustable (for seat and back support system ECS, see separate prescription form at angle

2 Seat Seat upholstery Adjustable seat depth 6 cm Solid seat, detachable With angled brake handle With extension arm, foldable Single-hand brake Brakes Red Black With angled brake handle Drum brakes g supports Black Detachable/swing-away with locking device (not for bow handle) Yes No With larger grip Elevating leg supports Mod 1 without calf support Mod 3 without calf support Mod with calf support foldable, adjustable in angle, depth and sideways Mod 3 with calf support foldable sideways in height two positions. From 40 cm seat width (with two leg supports) Options for Mod 1 and Mod 3 without calf support Attachment for calf support Attachment for calf-support, foldable Calf support Tube, standard length Foot support one piece Foot supports Flip-up, adjustable Tube, short length(-8 cm) only for short/narrow leg support Tube, long length (+10 cm) Flip-up, adjustable in angle g supports Others Amputee support adjustable in height, angle, depth and sideways Amputation weight, can be combined with Amputee support Plaster leg support with fixed 0 knee angle. Support plates are adjustable Material Plush Grey hygiene Rear wheels with quick release Pneumatic high pressure Pneumatic high pressure 1 Pneumatic high pressure 1 Pneumatic high pressure Solid Solid Solid Solid --- Aluminium Aluminium Aluminium Aluminium --- Handrims Stainless steel Stainless steel Stainless steel Stainless steel Cellular rubber Cellular rubber Cellular rubber Cellular rubber --- Vinyl coated (not with solid tyre) Vinyl coated Vinyl coated Vinyl coated ---

3 Single hand-drive (not with drum brakes) 0 Handrims on ght 4 ft 4 (100x30 mm) solid 7 (175x45 mm) semipneumatic Castors 5 (15x30 mm) solid (max 135 kg user weight) 8 (00x35 mm) semipneumatic 6 (150x30 mm) solid 8 (00x50 mm) semipneumatic 6,5 (165x30 mm) solid 8 (00x30 mm) pneumatic Front fork attachment Widened (moves castor 3 cm to the side for foot propulsion) Camber angle 0 Rear Pos A 46 48, B 44 46, Rear seat height (cm) C 4 44, D 40 4, E 38 40, F 36 38, G 34 36, Extra short front fork Castor height 4 * 34-39,5 cm cm 5 ** 36-44,5 cm cm Position Short front fork ,5 cm cm 1 6, ,5 cm cm Front seat height (cm) ** cm cm cm cm * Max 100 kg user weight ** Max 135 kg user weight Medium 3 6, cm cm front fork cm cm 8 x1 (pneumatic) 46,5-50,5 cm cm Long front fork 6,5 50,5-55,5 cm cm 8 5,5-56,5 cm cm Fork thickness 3 mm 4 mm 1 G 0 Cambervinkel Balance position For alternative seat height/seat angles, see Manual Cross G F E D C B A F E D C B A E C A balance position 1-6 (standard pos 4) 3

4 Accessories Cross With detatchable arm support plate, length 5 cm, height adjustable Massive moulded plate, length 5 cm, height adjustable With detatchable arm support plate, length 35 cm, height adjustable Massive moulded plate, length 38 cm, height adjustable right left 730- right left right left 517- left left right left 731- right left right left right left Cover arm support Fits arm support with massive moulded plate Dark grey plush, detachable, length 5 or 38 cm Padded 5 cm Quantity pcs Padded 38 cm Quantity pcs Gel 5 cm Quantity pcs Gel 38 cm Quantity pcs Hemi Detachable cover, dark grey plush, sideways angle adjustable Fits with long arm supports 731-1/ and / Detachable cover, dark grey plush Fits with long arm supports / and / right left right left pad wide and soft Fits arm support with massive moulded plate 8x40 cm, to be mounted on arm supports pcs 6873 Side support Thigh support Soft pad Black, adjustable in height To be mounted on short or long arm supports, front attachment is included. Limitations: 4 wheel, not in B1-, C1-, D1-, E1-, F1-, G1- wheel, not in C1-, D1-, E1-, F1-, G1 0 wheel, not in E1-, F1-, G1 For thigh support, velcro attachment right left Short right Short left Long right Long left 739- right left Mudguard Carbon fibre, adjustable in height and depth to fit rear wheel position right left Width expansion kit Extends rear wheels, brakes and arm supports 5 mm on each side (not together with drum brakes)

5 Tray Tray Hemi/ Communication Seat extension Cross back 3A To be mounted on long arm supports, transparent Tip up right/left Extends the seat depth up to 7 cm at rear, in combination with triangular back support Etac / Cross 5 XL / Seat width cm , , , right left 735- Seat width cm 6977 Seat cushion Comfort wedge Seat cushion Tidy Dark grey plush, 56 cm long, anatomically shaped, cut to individual seat depth Increases the contour. To be placed in the pocket of the inner front upholstery Wipeable Seat width cm , , , Seat width cm , Seat width cm , , , ECS seat- and backsupport Calf support cover Calf strap Padding for calf strap The seat- and back support system offers products and covers in different kinds of upholstery and fabrics (see separate prescription form at Dark grey plush For elevating leg support model 3 Black Dartex For elevating leg support model 3 Detachable, adjustable in length Quantity pcs Quantity pcs Seat width cm 45-47, , cm cm cm 6847 Foot support extension Mounted on foot support Seat width cm 45-47,5 Quantity pcs ,5 Quantity pcs Heel strap Adjustable in length right 4458 left 4458 Positioning belt Two-part with snap-lock. alt. attachment points on wheelchair frame

6 Head support Curved, padded. Adjustable in height, depth, sideways and angle. grey hygiene dark grey plush Head support attachment For Cross back 3A, mod 4 47, , ,5 813 Head support bracket For bow handle 5795 wedge Dark grey plush Short 15 cm Quantity pcs Long 30 cm Quantity pcs Side cushion Provides gentle lateral support. Used when the trunk support is too stabilising. (Combined with arm support and, if necessary, side stop) ght ft Side stop Straight or angled. Combined with wedge or side support cushion. Creates a more distinct stop and holds the wedge or side support cushion in place. Adjustable, swing-away and detachable Settable and detachable Straight pcs 8136 Widening 15 mm pcs 8137 Widening 30 mm pcs ght ft ght ft ght ft pcs pcs pcs pcs 8145 Dartex, fixed, adjustable in height, depth and width Quantity pcs 7395 PUR, fixed, adjustable in height, depth and width Quantity pcs 7917 PUR, swing away, adjustable in height and depth Medium right Medium left Large right Large left Anti-tip Telescoping, flip-up Quantity pcs 756 Cane holder right 737 left 737 Grey with logo Yellow with logo Spoke guard Other spoke guards see Tetra quick release adapter Quantity st

7 Locking strap Of folded chassis 7151 Toolkit 5174 For sizes see Gloves Item no Bags Cellular phone holder 9010 Etac Box 03, Anderstorp Sweden Tel Fax

, , Indicate height. Indicate height. Indicate angle. Indicate height: cm

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