Multi-Position Standing(MPS) System US PRICE LIST AND ORDER FORM Effective July 1, 2012

Transcription

1 Multi-Position Standing(MPS) System US PRICE LIST AND ORDER FORM Effective July 1, 2012 Date of Order: Dealer Name: Dealer Account #: PO #: Base MFR. PO #: Tag: Purchasing Contact: Phone: Fax: RTS/Therapist: Ship to Address: City: State: Zip: Client Info: Gender: Special Client Conditions: ORDER WILL NOT BE PROCESSED IF CLIENT MEASUREMENTS ARE NOT COMPLETED Client Height: Client Weight (lbs): A. Seat to Shoulder: B. Trunk Depth: C. Chest Width: D. Knee to Back: E. Seat to Top of Head: F. Elbow to Hand: G. Seat to Elbow: H. Hip Width: I. Knee to Heel: J. Knee Thickness: K. Calf Thickness: G A D E F I K J C H Up to 250 lb weight limit. Dependent on weight capacity of the power base. Seat Cushion Thickness: BASE TYPE SELECTION qfdx Select STF (1) : q ~ q21.25 ^...$950 qstorm* Select STF (1) : q ~ qarrowq Torque q21.25 ^...$950 q RangerX qshort Base ONLY WITH POWER STAND FEATURE ~ The client knee to heel (seat pan to foot plate) cannot be greater than 15.5 plus compressed cushion. (ie =17.5 ) ^ The client knee to heel (seat pan to foot plate) cannot be greater than 17.5 plus compressed cushion. (ie = 19.5 ) *Front casters are modified on the storm and the overall length of becomes the same length as a long base Storm. The Power Stand Feature uses two Group 34 Batteries ELECTRONICS Mark 6 Select :qmpj* *MPJ Joystick is required with Power Stand Feature Select Drive: qright qleft qspecialty Control* *Please specify: OTHER INFORMATION qg-trac Module q4 Pole Motors q2 PoleMotors qgb Motors Transport Ready Option: qyesqno If requesting Safety Lights on the FDX base they must be ordered from Invacare when the base is ordered. PAGE 1 of 5

2 SYSTEMS (2) MUST SELECT ONE SYSTEM Includes seat pan, back pan, armrests, armpads, fixed front rigging, electronics and standard switch controls TRx CG Tilt Only System (45 Tilt)(HCPCS code E1002) q $5,120 TRx CG Tilt (45 ) and Power Recline (178 ) System with Extended Shear Reduction (ESR) (HCPCS code E1007) q $8,950 POWER STAND MODULE(MUST BE ORDERED WITH A SYSTEM - ABOVE) TRx Power Stand Module for Tilt Only* $9,450 TRx Power Stand Module for Tilt/Recline/ESR Only*..$8,750 Comes with Synchronized Foot Platform (see page 4 for specifications) * Standard with upper and lower positioning straps; padded, removable chest bar, removable and height & depth adjustable knee blocks. ELEVATING SEAT SYSTEMS TRx Elevating Seat Module (3)** qup to 7 Elevation - 250lbs max $2,250 ** With Tilt/Stand Feature Seat to back angle will open to 14 and legrest will extend 13 during seat elevation - With Tilt/Recline/ESR/Stand legrest will extend 13 during seat elevation. SEAT SPECIFICATIONS Adult Seat Width q16 q17 (Width adjustable from 16 to 19 ) q18 q19 q20 (Width adjustable from 17 to 20 ) Adult Seat Depth q16 q17 (Depth adjustable from 16 to 19 ) q18 q19 q20 (Depth adjustable from 17 to 20 ) SEAT CUSHION OPTIONS qmatrx-ps Seat Cushion 16 w-20 w (HCPCS Code E2605).$345 qmatrx-vi Seat Cushion 16 w-20 w (HCPCS Code E2607)..$425 qmatrx-flo-tech Cushion 16 w-20 w (HCPCS CodeK0734) $475 q ON-CHAIR Cushion Credit ($90) FABRIC OPTIONS FOR MATRX-VI CUSHION q Onyx Fabric Upgrade for Matrx-Vi Cushion....$100 q Fusion Fabric Upgrade for Matrx-Vi Cushion...$100 q Vinyl Fabric Upgrade for Matrx-Vi Cushion.....$50 FINISHED BACK HEIGHT Measured from seat pan to top of back shell q20 q21 q22 q23 q24 q25 q26 q27 q 28 q29 q30 q31 q32 q33 q34 q35 BACK OPTIONS qtrx Rehab Back and Back cushion Finished height from 20 to N/C Finished height from 26 to $450 qmatrx Fabric Upcharge -for TRx Rehab back $100 UPGRADEABLE BACK OPTIONS qmatrx Contour Back (HCPCS Code E2613) $495 (For Systems wide under 300lbs) Specify actual back height dimension: q12 q15 q17 q21 qmatrx High Back (HCPCS Code E2620) $595 (For Systems wide under 300lbs) Specify actual back height dimension: q20 q22 q25 qmatrx PB Elite Back (HCPCS Code E2620) $625 (For Systems wide under 300lbs) qmatrx PB Elite Full Back (HCPCS Code E2620) $625 (For Systems wide under 300lbs) Specify actual back height dimension: q20 qmatrx PB Elite Deep Back (HCPCS Code E2620) $760 (For Systems wide under 300lbs) qmatrx PB Back (5 Contour) (HCPCS Code E2615).....$625 (For Systems wide under 300lbs) qmatrx PB Deep Back (7 Contour) (HCPCS Code E2615).$645 (For Systems wide under 300lbs)) ON-CHAIR Matrx Back Credit ($125) Onyx Fabric Upgrade qcontour Back qhigh Back $100 Fusion Fabric Upgrade qcontour Back qhigh Back $100 NOTE WHEN USING THE POWER STAND MODULE AND WHEN CHOOSING YOUR BACK HEIGHT A 7 GAP IS REQUIRED. FIXED LATERALS - FOR MATRX PB ELITE BACK q Standard Fixed LEFT - PBLS-L (HCPCS code E0956)......$100 Select pad :q Standard (7.5 x 5 ) )qsmall (5.5 x3 ) q Standard Fixed RIGHT - PBLS-R (HCPCS code E0956)....$100 Select pad :q Standard (7.5 x 5 ) )qsmall (5.5 x3 ) q Offset Fixed LEFT - PBOL-L (HCPCS code E0956) $110 q Offset Fixed RIGHT- PBOL-R (HCPCS code E0956)......$110 SWING AWAY LATERALS - FOR MATRX PB ELITE BACK qlateral Trunk Support Left pad (each) (HCPCS code E0956)...$100 q XS(3.25 x4.25 )qs(3.5 x5.25 )qm(3.75 x5.75 )ql(4.25 x6.5 ) qlateral Trunk Support Right pad (each) (HCPCS code E0956).$100 q XS(3.25 x4.25 )qs(3.5 x5.25 )qm(3.75 x5.75 )ql(4.25 x6.5 ) SELECT SWING AWAY HARDWARE TO CONVERT ABOVE: q Elite Back Swing Away Hardware q LEFT (HCPCS code E1028) $195 q RIGHT (HCPCS code E1028) $195 q Offset Elite Swing Away Hardware q LEFT (HCPCS code E1028) $195 q RIGHT (HCPCS code E1028) $195 PAGE 2 of 5

3 HEADRESTS & MOUNTING HARDWARE Headrests with Fixed Mounting Hardware (HCPCS code E0955) qconcepts Standard Headrest $295 qstealth All Positioning Headrest Large (AP485) $242 qstealth All Positioning Headrest X-Large (AP585)......$242 qnino Comfort Plus 6 (CPN350) $242 qstealth Comfort Plus 8 (CP450) $242 qstealth Comfort Plus 10 (CP250) $242 qstealth Comfort Plus 14 ( CP150) $242 qonyx Auto Style Headrest - Straight Mounting available only....$350 Headrest Swing Aways and Mounts - Does not include the Headrest qconcepts Detachable Mounting Hardware $200 qstealth s World s Best Headrest Hardware (TWB485)...$220 OMIT: Headrest N/C ARMRESTS qtrx Height & Angle Adjustable Cantilever Flip Back with Quick Lock Mechanism^(each) Armrests (Height range is ) STD Armrest heights greater than 13 (requires higher back height)....rfq ARMPADS qstandard Pads STD Full (2.25 x14 ) qleft qright Desk (2.25 x10 ) qleft qright qflat Pads- (Pair) $55 Full (3 x14 ) qleft qright Desk (3 x10 ) qleft qright qgel Pads- (Pair) Narrow (2 x12 ) qleft qright..$150 Wide (3.5 x12 ) qleft qright..$150 Long (3.5 x14 ) qleft qright..$180 qergonomic Arm Trough - LEFT (4.5 x13 ) $85 (HCPCS Code E2209 qergonomic Arm Trough - RIGHT (4.5 x13 ) $85 (HCPCS Code E2209) qflat Hand Pad - LEFT (4.5 x5 )(HCPCS Code K0108)......$55 qflat Hand Pad - RIGHT (4.5 x5 )(HCPCS Code K0108)....$55 STEALTH LATERALS (4) q FMTWB-L Stealth Laterals -Fixed (pair) $220 Pad Size: qs(3 x 5 ) ql(4 x 6 ) (HCPCS code E0956) SELECT SWING AWAY HARDWARE TO CONVERT ABOVE: qtwb-l Stealth Adjustable Swingaway Hardware(pair) (HCPCS code E1028) $440 LATERAL HIP SUPPORTS q Lateral Hip Support Pad with Fixed Mounting LEFT..$120 q(5.5 W x 4.5 H)q(7 W x 5.75 H)q(9 W x 4.5 H)q(13 W x 4.5 H) (HCPCS code E0956) q Lateral Hip Support Pad with Fixed Mounting RIGHT.$120 q(5.5 W x 4.5 H)q(7 W x 5.75 H)q(9 W x 4.5 H)q(13 W x 4.5 H) (HCPCS code E0956) q Onyx Fabric Upgrade $100 HARDWARE TO CONVERT ABOVE HIP SUPPORT TO REMOVABLE/SWINGAWAY HIP OR KNEE SUPPORTS qtrx Lift Off, Removable Hardware for Hip Supports q LEFT (HCPCS code E1028) $195 q RIGHT (HCPCS code E1028) $195 *Please specify pad height(seat pan to top of pad): qstealth Flip Down Lateral Support (mounted at the knee only) q LEFT (HCPCS code E1028) $215 q RIGHT (HCPCS code E1028) $215 CHEST STRAPS q Chest Strap 5 W x 24 L (PNG 50193) STD q X-Style Chest Strap Medium 28 L x 24 W (PNG 30170) $231 q X-Style Chest Strap Large 32 L x 26W (PNG 30056)...$231 LAP BELTS q Padded Lap Belt 2 point - BP-PLB2 (HCPCS code E0978)..STD ARMPADS ACCESSORIES qtrx Elbow Block RIGHT (prevents arm from slipping off)......$195 Select Pad Size: qxs(3.25 x4.25 )qs(3.5 x5.25 )qm(3.75 x5.75 )ql(4.25 x6.5 ) Select Extension Vertical: qs(3 ) ql(5 ) Horizontal:qS(5 ) ql(7 ) qtrx Elbow Block LEFT (prevents arm from slipping off) $195 Select Pad Size: qxs(3.25 x4.25 )qs(3.5 x5.25 )qm(3.75 x5.75 )ql(4.25 x6.5 ) Select Extension Vertical: qs(3 ) ql(5 ) Horizontal:qS(5 ) ql(7 ) qstealth Swing-Away Elbow Support - RIGHT......$290 Select Pad Size: qs(3 x 3 )qm(3 x4 )ql(3 x 10 ) qstealth Swing-Away Elbow Support - LEFT $290 Select Pad Size: qs(3 x 3 )qm(3 x4 )ql(3 x 10 ) PAGE 3 of 5

4 POWER CENTER MOUNT FOOT PLATFORM OPTIONS MUST BE COMPLETED Knee to Heel: Cushion Thickness: (Subtract) Cushion Immersion:(Add) Seat Pan to Footplate:(Total) POWER STANDER FOOT PLATFORM OPTION Synchronized Center Mount Foot Platform (Stander)....STD Specify Knee to heel Comes with Individual Flat Calf Pads POWER STANDER KNEE BLOCKS/SUPPORT Height and Depth Adjustable Knee Blocks (7 W X 4 H ).....STD - 2 of independent height and depth adjustment - Knee blocks are removable and stored on the side of the chair when not in use POWER CENTER MOUNT FOOT PLATFORM OPTIONS BDC Belt Drive Center Mount ArticulatingFootPlatform (5)(6) For Tilt Recline Stand Systems Only (HCPCS code K0108)...$3,295 Specify Finished Leg Length: q std q18 or greater....suggested Retail $850. RFQ required Comes with Individual Flat Calf Pads FOOT PLATE OPTIONS FOR CENTER MOUNTS FDX Foot Plate Option Only Measurement in Inches ELECTRONICS SWITCH MOUNTING qleft qright qdo Not Mount qspecialty Controls Please fill out Specialty control configuration sheet on page 6 ELECTRONICS qenhanced Single Function Control Module* $1,200 (HCPCS code E2310) *Tilt Stand Function Only qdual push button qthrough Joystick qthrough Specialty Control- call Customer Service qenhanced 2-5 Function Control Module $2,350 (HCPCS code E2311) qfour button 8-Way Switch qthrough Joystick qthrough Specialty Control- call Customer Service BATTERIES qmk GROUP 34 Battery (M34 SLD G) Each Quantity ( ) (HCPCS code K0108) $265 INSTALLATION qinstallation by Motion Concepts (7) N/C Total Retail Value $ qindividual Footplates for BDC STD. In cast aluminum with built in heel cups and rubber mat Left: qs(5 W x 7.5 D)qM(5.5 Wx9.5 D)qL(6 Wx11.5 D).STD Right:qS(5 W x 7.5 D)qM(5.5 Wx9.5 D)qL(6 Wx11.5 D).STD Storm Foot platform OptionOnly qmedium Flip-up Foot Platform for BDC (10 W x 10 D) STD PAGE 4 of 5

5 UltraLow Multifunction Standing System NOTES 1 Seat-to-floor height is measured at the front of the seat pan based on a standard seat size. Seat to floor heights may vary +/-.25 dependent on conditions of the power base and on seat depths greater than 18. Suspension castors may affect seat-to-floor height up to an additional Systems are designed for use with a 2-3 cushion. 3 These systems are not available over 20 wide by 20 deep and increase seat to floor height. 4 Laterals are not available with the MaTRx PB of PB Elite Backs. 5 Includes a flip up foot platform or footplates. May increase seat-to-floor height. 6 Under normal usage Power Legrest actuators tend to be louder than Tilt/Recline Actuators and increase seat to floor height. 7 Batteries may be required at time of installation, please call to confirm. MPS Considerations Prior to evaluation and use of the Motion Concepts Power standing system, all consumers should consult with a qualified physician and receive medical clearance and approval to use assisted standing devices. An experienced Occupational or Physical therapist should also be consulted and present during the evaluation and prescription process. Range of motion of the hips, knees & ankles (bilaterally) should be within functional limits for standing as determined by a clinician. Limitations of range of motion can result from many conditions (spasticity, heterotrophic ossification, hip dislocation, etc.) which can cause orthopedic changes and prevent an ergonomic standing posture. Blood pressure Decreased muscle tone can make it difficult for blood to circulate from the lower extremities back to the lungs and heart. It may be necessary for the consumer to wear compression stockings on their legs and possibly an abdominal binder to prevent light headedness and DRAFT blacking out. Clinicians should monitor for orthostatic hypotension, elevated heart rate or other cardiovascular conditions. Bone density If the wheelchair user (patient) has not been ambulatory or fully weight-bearing for more than 6 months, it is recommended that a bone density study be performed to ensure that the long bones of the lower extremities will be able to physically support their weight in a standing position. Generally speaking, the longer the amount of time since a person has been ambulatory, the greater the risk for bone mineral loss and decreased bone density. Other contraindications may exist; medical professionals must be consulted in determining each individual s indications and contraindications for use of an assisted standing device. PAGE5 of 5