Company Name Account # Phone # P.O.# Date. Ship To Name & Address Special Note

Transcription

1 Price List and Order Form Effective October 9, 006 Revised April 9, 007 For ease of ordering, contact Customer Service Toll Free at: Fax: To order Literature: Company Name Account # Phone # P.O.# Date Ship To Name & Address Special Note HCPCS codes are not intended to be, nor should be considered billing or legal advice. Providers are responsible for determining the appropriate billing codes when submitting claims to the Medicare Program and should consult an attorney or other advisor to discuss specific situations in further detail. Base CHAIR TYPE TDXSP TDX SP with MK6i (K088/K0850)...5, TDXSPBASE TDX SP Base Only with MK6i...5,00.00 TDXSPSEAT TDX Seat Only * TRANSPORT TIE-DOWN TRRO includes four factory-installed transport brackets and a wheelchair anchored pelvic belt. TRRO has been crash-tested in accordance with ANSI/RESNA WC Vol. Section 9 Frontal Impact Test requirements for wheelchairs with a 68 lb. crash dummy, which corresponds to a person with a weight of lbs. to 09 lbs. TRBKTS includes four factory-installed wheelchair transport brackets. TRBKTS has not been crash-tested in accordance with WC9. Use these transport brackets only to secure an unoccupied wheelchair during transport. As of this date, the Department of Transportation has not approved any tie-down systems for transportation of a user while in a wheelchair, in a moving vehicle of any type. It is Invacare s position that users of wheelchairs should be transferred into appropriate seating in vehicles for transportation and use be made of the restraints made available by the auto industry. Invacare cannot and does not recommend any wheelchair transportation systems. * Transport Tie-Down option is not retrofittable to existing models and is not field serviceable. TRRO FEATURES FOR TDX SP Features Required for TRRO TDXSP 70 Swingaway, 70 Tapered, or Manual Center Mount Front Riggings Any Arm Style Adjustable Rehab Seat with Adjustable Seat Tilt & Back Angle Sectional or Straight Rear Uprights or No Push Handles " x 3" Tires with Foam Filled Inserts 90 or 95 Back Angle 8" - " ASBA Back Height Any Seat Width Any Seat Depth 300 lb. or 00 lb. user weight limit Low Seat-to-Floor Height NF Batteries Any Color Frame Finish Optional Features for TRRO Adjustable Angle Flip UpFooplates, Flip-Up Composite Footplates or Aluminum Footplates-Deluxe, Wheel Locks Calf Strap Heel Loops w/ankle Straps Impact Guards One Sided Fork Package SPJ+, MPJ+ Joystick All PSR+ / PSF+ Joysticks Proportional Attendant Control T Handle Flexible Joystick Ext. Left Hand Mounted Joystick Straight Handle Flexible Joystick Ext. Easy Remote Programmer Reinforced Back Upholstery TRANSPORT TIE-DOWN TRRO Transport Ready Option TRBKTS Wheelchair Transport Brackets USER WEIGHT LIMITS U300 User Weight <300 lbs (K088)...Standard 3 U00 Heavy Duty Upgrade to <00 lbs. (K0850)...,75.00 SEAT-TO-FLOOR HEIGHT LOW Seat-to-Floor Low...Standard MED Seat-to-Floor Medium...No Charge TALL Seat-to-Floor Tall...No Charge WHEEL OPTION (PAIR) 30-3 '' X 3'' Pneumatic Tires...Standard 3-3 '' X 3'' w/foam Filled Inserts FORK OPTION FKPKG One-Sided Fork Package TDXSP comes standard with: 300 Lb. user weight capacity, 5.8 M.P.H. top speed, -pole motor package & MK6i SPJ + Joystick, MK690 Controller, Quiet Stability Lock. Base only comes standard with MK690ACC Controller and SPJ+ with PSS Joystick. Additional joystick options available.. Package includes -pole motors and 6 M.P.H top speed with <300 lb. user weight limit. 3. Package includes -pole motors and 5 M.P.H top speed with <00 lb. user weight limit. Please note that all TRRO chairs are set at a 0 seat angle page

2 FRAME FINISH CONTEMPORARY P Wet Black...No Charge 60P Silver Metallic...No Charge 7P Silver Vein...No Charge 05P Midnight Blue...No Charge 5P Black Prism...No Charge TOO HOT 30P Sunny Yellow...No Charge 6P Electric Red...No Charge 9P Bubblegum Pink...No Charge 0P Grape Madness...No Charge FRAME FINISH CONTINUED WAY COOL 6P Electric Blue...No Charge 0P Electric Teal...No Charge P Lolly Pop Blue...No Charge P Cosmic Blue...No Charge 5P Emerald Green...No Charge 7P Grasshopper Green...No Charge Seat SEAT SELECTION ADJASBA Adj. Rehab Seat w/adj. Seat Tilt & Back Angle...Standard ADJRECL Manual Recline for Adjustable ASBA (E6) CTS Contoura Seating OMCU Omit Contoura Seat Cushion...Less ADJUSTABLE SEAT WIDTH RANGE 6W " to 6" Seat Width Range...No Charge 60W 6" to 0" Seat Width Range...No Charge 0W 0" to " Seat Width Range...No Charge ADJASBA SEAT WIDTH W Seat Width '' W3 Seat Width 3'' W Seat Width " W5 Seat Width 5"...No Charge W6 Seat Width 6"...No Charge W7 Seat Width 7"...No Charge W8 Seat Width 8"...No Charge W9 Seat Width 9"...No Charge W0 Seat Width 0" W Seat Width " W Seat Width " W3 Seat Width 3" W Seat Width " ADJUSTABLE SEAT DEPTH RANGE 8D " to 8" Seat Depth Range....No Charge 69D 6" to 9" Seat Depth Range....No Charge 9D 9" to " Seat Depth Range....No Charge ADJASBA SEAT DEPTH SETTING D Seat Depth '' D3 Seat Depth 3'' D Seat Depth '' D5 Seat Depth 5''...No Charge D6 Seat Depth 6''...No Charge D7 Seat Depth 7''...No Charge D8 Seat Depth 8''...No Charge D9 Seat Depth 9''...No Charge D0 Seat Depth 0'' D Seat Depth '' D Seat Depth '' FIXED ARM TYPE (PAIR) 8F Full Length Fixed Height Conv...No Charge 8F Desk Length Fixed Height Conv....Standard ADJUSTABLE ARM TYPE (PAIR) 9F Full Length Adj. Hgt Conv. (E0973) F Desk Length Adj. Hgt Conv. (E0973) MIXED HEIGHT ADJUSTABLE ARM TYPE (EACH) 9FR Full Length Adj. Hgt Right (E0973) FR Desk Length Adj. Hgt Right (E0973) FL Full Length Adj. Hgt Left (E0973) FL Desk Length Adj. Hgt Left (E0973) ASBA SEAT BACK TYPE SECT Sectional Rear Uprights...Standard SRUP Straight Rear Uprights...No Charge 970P No Push Handles (Straight Canes) L866 Omit Rear Uprights...Less 0.00 ASBA SEAT BACK ANGLE DEGREE 90BA 90...Standard 95BA 95...No Charge. Selected seat depth on Contoura assumes " of back cushion compression. For example: When choosing an 8" depth the measurement from the front of the back cushion to the front of the seat pan equals 7". The Contoura back cushion is " thick. Please refer to page 6 for seat size offerings.. Must select "-8" Depth Range (8D) when ordering the "-6" Seat Width Range (6W). 3. Contoura available in even Seat Widths from 6"-".. User weight limit is 50 lb. 5. Available only with 00 lb. package. 6. Contoura available in Seat Depths 6"-". page

3 Seat ASBA SEAT BACK HEIGHT BH Back Height ''...No Charge BH3 Back Height 3''...No Charge BH Back Height ''...No Charge BH5 Back Height 5''...No Charge BH6 Back Height 6''...No Charge BH7 Back Height 7''...No Charge BH8 Back Height 8''...No Charge BH9 Back Height 9''...No Charge BH0 Back Height 0''...No Charge BH Back Height ''...No Charge BH Back Height ''...No Charge BH3 Back Height 3''...No Charge BH Back Height ''...No Charge CONTOURA BACK HEIGHT TSBH5 Back Height 5''...No Charge TSBH95 Back Height 9.5''...No Charge MK6i CONTROLLERS MK Amp Controller...Standard STANDARD DRIVER CONTROL SPJPLUS SPJ + Single Drive Joystick...Standard EXPANDABLE CONTROLLER SYSTEMS MPJM6U MPJ + Multiple Drive Joystick (E377) PSFM6 Personal Joystick, Inductive on Front (E399) PSRM6 Personal Joystick, Inductive on Rear (E399) PBOD Push Button On/Off w/pb Drive Select...No Charge, 3 PBSS Push Button On/Off w/speed Select...No Charge OR On/Off Mounted Right...No Charge OL On/Off Mounted Left...No Charge ASLRDYM6 MK6 Display Only (No Driver Control) (E377) ALTERNATIVE PROPORTIONAL CONTROL SYSTEMS 500M6 Prop RIM Head Control w/display (E37)..., SMHD Small Headrest...No Charge LGHD Large Headrest...No Charge 558MM6 Compact Joystick w/display (E373)...,30.00 FOR YOUR ASL DRIVE SYSTEM NEEDS PLEASE REFER TO THE FOLLOWING: ASL SINGLE INVOICE PRICE LIST FORM # ALTERNATIVE DIGITAL CONTROL SYSTEMS 5 SNPM6 Sip-N-Puff Digital Interface Box (E35)..., M6 Wafer Board & Digital Interface Box (E3)..., M6 Mini Tash Joystick & Digital Interface Box (E3).., SIP N PUFF KIT PKG3666 Therafin Sip-N-Puff Breath Tube Kit (E36) ADDITIONAL CONTROL CHOICES 558M6 Compact Joystick - Less std Mount PACM6 Wafer Board Mini Tash Joystick Proportional Attendant Control M Digital Attendant Control JOYSTICK MOUNTING HARDWARE 7 7 QLAM6 QLA Quad Link Retract. Joystick Mnt MPJ+ (E08) Quad Link Retract. Joystick Mount SPJ+(E08) ARM50 Stealth Height Adjustable Joystick Mount (E08) LEFT Left Handed Mounted Joystick...No Charge RIMHW RIM Hardware For 500 (E08) PKG3669 Complete Bib Assembly (Tash/558) GATMPJM6 Gatlin Midline for MPJ (E08) GAT8 Gatlin Midline for 8 (E08) RCM Rear Cane Mount for Compact Joystick Electronics BACK HEIGHT RECLINER BHR8 Back Height 8''...No Charge BHR0 Back Height 0''...No Charge BHR Back Height ''...No Charge BHR Back Height ''...No Charge BHR6 Back Height 6''...No Charge SEAT POSITIONING STRAPS 8 3BK Airline Buckle Seat Pos. Strap Push Button Style Seat Pos. Strap...Standard CHEST POSITIONING STRAPS 73BK Airline Buckle Chest Pos. Strap (E0960) Push Button Style Chest Pos. Strap (E0960) BK Hook & Loop Chest Pos. Strap (E0960) ELECTRONIC ACCESSORIES 83M6 MK6i Programmer w/pro Memory Card SD Pro Memory Card (USB Ready) T Handle Flexible Joystick Ext. (E33) Straight Handle Flexible Joystick Ext. (E33) Chin Cup (E3) AVPS V MK6 Auxiliary Power Source AUXM6 Auxiliary Module For & AUX3M6 Auxiliary Module For 3 & MPY Monoport "Y" Cable for MPJ+ or Display POWER SEATING ACCESSORIES 9 WSB Four-Way Switch Box for Individual Power Leg Control...No Charge 0 SWSB Multiple Actuator Intrfce Bx for Pwr Legs (E3).., FWT Four Way Toggle...No Charge QPB Four Push Buttons...No Charge ASL OPTIONAL ACCESSORIES EGSBLK Egg Switch - Black ASL30 Light Wobble Switch w/6 Mount ASL0J Fiber Optic Switch ASL08J Adjustable Proximity Switch ASL50JM6 Remote Emergency Stop Switch TOD-SS: Toggle On/Off-Drive Select, Speed Potentiometer Standard.. PSRM6 Only. 3. Drive Select through mode switch, or mode switch and Joystick Command.. Display Only, No Driver Control. Allows choice from order form. 5. Must also use either a Multiple Drive Joystick or MK6i Display. 6. Requires SNPM6 Sip-N-Puff Interface Box. 7. QLAM6 and QLA come standard with ARM BK not available on " - 5" wide. 9. Required with all multiple actuator systems. Provides a D-9 port for the Four-Way Toggle or Four-Push Button. 0. Replaces the Four-Way Switch Box and allows multiple actuator operation through the driver control.. Not available with SPJ+ Joystick. Must add MK6 Auxiliary Power Source. page 3

4 Miscellaneous BACK ACCESSORIES L860 Omit Back Upholstery...No Charge RBP Reinforced Back Upholstery...No Charge MISCELLANEOUS ACCESSORIES 303 Wheel Locks SEAT0 Oxygen Holder (ADJASBA Seat Only)(E08) BATTERY TRAY TYPE TRY NF Style Tray...Standard TRY Group Style Tray...No Charge BATTERIES NFBATTERY NF Battery (On Chair) (E36) BATTERY Gel Battery (On Chair) (E363) FRONT RIGGING CENTER MOUNT CTMT-F Center Mount Adj. Knee Angle CTMT-FJ Junior Center Mount Adj. Knee Angle CENTER PIVOT STYLE (PAIR) 70NHD 70 Swingaway Footrests...Standard 5 70STAPER 70 Tapered Footrests...No Charge 6 AT55 Manual ELR (E0990) PIN STYLE HEMI (PAIR) PHW93 70 Swingaway Footrests...No Charge PHALA Manual Articulating/ELR (K0053) POWER ELEVATING LEGRESTS - ARTICULATING ELRPW Power ELR w/articulation 0" Ext. (E00)..., , 8 7, 8 ELRPW Power ELR w/articulation " Ext. (E00)..., FOOTBOARD 90FB 90FB Flip up Removeable Footbaord FOOTPLATE OPTIONS (PAIR) 9 65 Composite Footplates...No Charge Extra Large Aluminum Footplates...No Charge AT553 Adjustable Angle Flip-Up Footplates FBCTMT Footboard for Center Mount FOOTREST/LEGREST ACCESSORIES 337 Calf Strap (K0038) BK Heel Loops w/ankle Straps (Pair) (E095) IMPACTG Impact Guards LPT Longer Pivot Slide Tube For ALPT Longer Pivot And Slide Tube ALPT Longer Pivot And Slide Tube " Front Riggings. All front rigging options include a standard footplate with the exception of the 70NHD.. Allows 60 to 90 degree static knee angle positioning with a drop back lever for easier transferring. Extension range.5" - 5". Available on low seat-to-floor only. 3. Allows 60 to 90 degree static knee angle positioning with a drop back lever for easier transferring. Extension range 9.5" - ". Available on low seat-to-floor only.. With seat widths of " to " and depth of 6", must pick footplate 350. The AT553 is not available. 5. Standard with impact guards. Not available with widths 9" to " and 6" deep seat. 6. Not available with 6" wide by 6" to 8" deep or 7" wide by 6" deep and low seat-to-floor. 7. Not available with SPJ+ joystick. 8. Independant powered evelaving legrests including elevating and articulating legrests with angle adjustable footplates. Not available with the 6" or 7" seat depths. Extension range 3"-0". Sold as pair. 9. Not available with AT55 and 7" wide by 6" deep and low seat-to-floor. 0. Not available with AT55 and 6" wide by 6"-8" deep or 7" wide by 6" deep and low seat-to-floor.. TRY Base WIdth ": TRY Base Width 5.5".. One piece footboard for Center Mount (CTMT-F) Riggings. Seating FOR YOUR SEATING NEEDS PLEASE REFER TO THE FOLLOWING: REHAB SEATING & POSITIONING PRODUCTS SEE PRICE LIST FORM # page

5 TDX SP Specifications Seat Width Range: (in " increments) ADULT (Adjust) JUNIOR (Adjust) 6 to -inches to 6-inches Seat Depth Range: to -inches to 6-inches Back Height Range: Back Angle Range: to -inches 85 to 05 in 5 increments Seat-to-Floor (approximate) Standard: 0 Medium: 0 Tall: 0 At 5 add.5" Batteries (not included) NF batteries with terminal configuration (positive on the left and negative on the right) MUST be used. NF batteries that have the reverse terminal configuration MUST not be used. Terminals MUST have a cross hole for proper battery connection. GP batteries with terminal configuration (negative on the left and positive on the right) MUST be used. GP batteries that have the reverse terminal configuration MUST not be used. Terminals MUST have a cross hole for proper battery connection. See Owner s Manual, part number 809. These recommendations MUST be followed otherwise injury and damage may occur. Overall Width of Base: -inches (w/o Joystick) Overall Height (with 0" back height & 0 seat angle) Standard: 35.5-inches Medium: 37.5-inches Tall: 39.5-inches Overall Length: 35.5-inches 3-inches w/o front rigging w/ 90 front rigging Weight Pole Motor Drive Axle: W/O NF Batteries: With two () NF Batteries: Non-Adjustable Drive Wheels/Tires: (Foam Filled or Pneumatic) Standard: 66 lbs. 6 lbs. X 3-inches Contoura Seat Sizes D6 D7 D8 D9 D0 D D W6 X X X X X * * W8 X X X X X * * W0 X X X X X X X W * * X X X X X W * * X X X X X *Not available with Contoura Seat Cushion. Back Heights 5" or 9.5" Memory Card - BASIC Standard with ALL Expandable Control Systems (MPJ+, PSR+, PSF+, MK6i Display). Used to Back Up/Restore Programmed Settings for Only One Chair. May be given to user or kept with provider's files for safe keeping. Does not Contain Advanced Diagnostics/Help Screens/File Structure. Not compatible with SPJ+ Joysticks. Memory Card - PROFESSIONAL Standard with ALL MK6i Programmers. Available also with USB Card Reader on Order Form. Contains Advanced Diagonstics, Help Screens, Software Updates, File Storage/Retrieval. Used to back up multiple chairs and programming settings. Intended for use by qualified providers only. Not compatible with SPJ+ Joysticks. Weight Limit 300 Pounds (Standard) Invacare recommends all wheelchairs be fitted and programmed to the consumer under the guidance of a healthcare professional, knowledgeable of the particular limitations of the product. NOTE: All weight limits are inclusive of add-on equipment and seating systems. All specifications and dimensions are approximate. Invacare Corporation USA One Invacare Way Elyria, OH USA All rights reserved. Trademarks are identified by the symbols and. All trademarks are owned by or licensed to Invacare Corporation unless otherwise noted. Therafin is a registered trademark of W/R Medical Electronics Co. Products designated by ASL are Manufactured by Adaptive Switch Labs, Inc. Specifications and prices are subject to change without notification. 007 Invacare Corporation Form No Rev 007 P006_053