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

Transcription

1 ross 5 Prescription form 7586J Reference: Name: Tel: ate: Standard 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) , , , , , ,5 330 Side frame ctive (Only in colour -0) rame colour ack support ross back 3 lack -0 Silk grey -94 oral -96 Yellow -99 ark blue -93 Moss green -95 Type Lumbar angle Standard +7 Triangular Heather purple -97 ack support height Standard 3-45 cm (std 40 cm) Indicate height cm Lumbar angle ack support height High 38-5 cm (std 46 cm) Indicate height cm ack support angle (std + ) Indicate angle ack support angle over Standard omfort Tidy ack support ross back ack support ross back, widened ontinuosly adjustable cm. Standard 35 cm ontinuosly adjustable cm. Standard 35 cm xtends the width 5 cm Indicate height: cm Indicate height: cm over standard over comfort ack support tubes for hard shell back support, S ack support tubes for hard shell widened back support, S ack support angle Push handles Push handles etachable, height adjustable ontinuosly adjustable cm Standard 35 cm ontinuosly adjustable 37-4 cm Standard 37 cm xtends the back support width by 5 cm Standard + = 9 between back and seat ow handle etachable, height adjustable (for seat and back support system S, see separate prescription form at Indicate angle Push handles fixed for ross back 3 (seat width cm)

2 tac / ross 5 / ixed back support with fixed push handles ixed upholstery ack support angle adjustable Standard + = 9 between back and seat djustable upholstery Indicate angle ack support height settings 37,5 cm 40 cm 4,5 cm 45 cm Seat Seat upholstery djustable seat depth, 6 cm Solid seat, detachable ixed seat upholstery (only with ixed back support and fixed back support upholstery) With angled brake handle With extension arm, foldable Single-hand brake Ri Ri Ri rakes Le Le Le Red lack With angled brake handle rum brakes Standard (not for bow handle) With larger grip Leg supports lack etachable/swing away with locking device Standard Narrow Short/Narrow Ri Ri Ri Le Le Le Yes Yes Yes No No No levating leg supports Mod 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 two height positions. rom 40 cm seat width (with two leg supports) Ri Ri Ri Ri Le Le Le Le Options for Mod and Mod 3 without calf support ttachment for calf support Ri Le ttachment for calfsupport, foldable Ri Le alf support Ri Le oot supports lip-up, adjustable in depth, angle and height. Tube, standard length Tube, short length (-8 cm) only for short/narrow leg support Tube, long length (+0 cm) ootrest one piece lip-up, adjustable in angle. Leg supports Others mputee support adjustable in height, angle, depth and sideways mputee weight an be combined with amputee support ootrest one piece compl. 35/37,5 djustable in height, depth and angle. etachable Plaster leg support With fixed 0 degree knee angle. Support plates are adjustable Ri Ri Ri Ri Le Le Le Le Material Plush rey hygiene

3 tac / ross 5 / arbon 4 (not with drum Pneumatic high pressure Pneumatic high pressure Pneumatic high pressure Pneumatic high pressure Rear wheels with quick release Pneumatic 3/8 (not with drum Pneumatic 3/8 (not with drum Pneumatic 3/8 (not with drum Pneumatic 3/8 (not with drum Solid Solid Solid Solid 6 Pneumatic high pressure Pneumatic 3/8 (not with drum Solid 0 4 arbon 4 (not with drum luminium luminium luminium luminium Stainless steel Stainless steel Stainless steel Stainless steel ellular rubber ellular rubber ellular rubber ellular rubber Vinyl coated (not with solid tyre) Vinyl coated Vinyl coated Vinyl coated Handrims 6 luminium Stainless steel ellular rubber Vinyl coated Single hand-drive (not with drum 0 Handrims on Right 4 Left 4 (00x30 mm) solid 7 (75x45 mm) semipneumatic astors 5 (5x30 mm) solid 8 (00x35 mm) semipneumatic 6 (50x30 mm) solid 8 (00x50 mm) semipneumatic 6,5 (65x30 mm) solid 8 (00x30 mm) pneumatic ront fork attachment Standard Low widened (for 4 castors) Widened (moves castor 3 cm to the side for foot propulsion) amber angle 0 Rear wheel Pos 46 48, , Rear seat height (cm) 4 44, , , , ,5 39-3

4 tac / ross 5 / astor Indicate height Position xtra short front fork 4 (00 kg user weight) 34-39,5 cm cm ,5 cm cm Short front fork ,5 cm cm 6,5 4-46,5 cm cm ront seat height (cm) 3 3 Medium front fork cm cm cm cm 6, cm cm cm cm 8 x (00x50 mm) 46,5-50,5 cm 8 x (pneumatic) 46,5-50,5 cm Long front fork 6,5 50,5-55,5 cm cm 8 5,5-56,5 cm cm 0 amber angle alance position or seat height/seat angles, see front/rear seat height above Indicate balance position -6 (standard pos 4) ccessories ross rm support rm support rm support rm support With detatchable arm support plate, length 5 cm, height adjustable djustable with fingerscrew Massive moulded plate, length 5 cm, height adjustable djustable with fingerscrew With detatchable arm support plate, length 35 cm, height adjustable djustable with fingerscrew Massive moulded plate, length 38 cm, height adjustable djustable with fingerscrew right 730- left 730- right left right 57- left 57- right left right 73- left 73- right left right 573- left 573- right left over arm support its arm support with massive moulded plate ark grey plush, detachable, length 5 or 38 cm Padded 5 cm Quantity pcs Padded 38 cm Quantity pcs el 5 cm Quantity pcs el 38 cm Quantity pcs

5 rm support Hemi etachable cover, dark grey plush, sideways angle adjustable its with long arm supports 73-/ and 7350-/ etachable cover, dark grey plush, sideways angle adjustable its with long arm supports 573-/ and 6380-/ tac / ross 5 / right left right left rm support pad wide and soft its arm support with massive moulded plate 8x40 cm, to be mounted on arm supports pcs 6873 Side support Thigh support Soft pad lack, adjustable in height To be mounted on short or long arm supports, front attachment is included. Limitations: 4 wheel, not in -, -, -, -, -, - wheel, not in -, -, -, -, 0 wheel, not in -, -, or thigh support, velcro attachment right 589- left 589- Short right 739- Short left 739- Long right 739- Long left 739- right left Mudguard arbon fibre, adjustable in height and depth to fit rear wheel position right left Width expansion kit xtends rear wheels, brakes and arm supports 5 mm on each side (not together with drum 7533 Tray To be mounted on long arm supports, transparent Seat width cm , , , , Tray Hemi Non-slip cover for Tray Hemi Incl. cover with velcro lock or table as above Seat width rm support short Seat width rm support long 35 cm cm ,5 cm ,5 cm cm cm ,5 cm ,5 cm cm cm ,5 cm ,5 cm cm cm cm Quantity pcs ,5-50 cm Quantity pcs 8634 Tray Hemi/ ommunication Seat extension ross back 3 oldable, adjustable in depth and width. Transparent xtends the seat depth up to 7 cm at rear, in combination with triangular back support right 735- left 735- Seat width 35-4,5 cm 6976 Seat width cm

6 tac / ross 5 / Seat cushion omfort wedge Seat cushion Tidy ark 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 35-37, , Seat width cm , , , , ,5/ S seat- and back support alf support cover alf 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 ark grey plush or elevating leg support model 3 lack artex or elevating leg support model 3 etachable, adjustable in length Quantity pcs Quantity pcs Seat width cm 35-37, , , , cm cm cm 6847 oot support extension Heel strap Mounted on foot support djustable in length Seat width cm 40-4,5 Quantity pcs ,5 Quantity pcs Quantity pcs right 4458 left 4458 Positioning belt Two-part with snap-lock. alt. attachment points on wheelchair frame Quantity pcs 5668 Head support urved, padded. djustable in height, depth, angle and sideways. grey hygiene dark grey plush

7 Head support incl. height adjustable tube 45 attachment, to be mounted on bow handle tac / ross 5 / With side support, plush, padded urved 50x40 mm With sideways adjustability Height adjustable tube Head support attachment 90 attachment urved , , Head support attachment or ross back 3, mod ,5 83 4, Head support bracket or bow handle , , ack support brace or ross back 3, mod ,5 8 4, , , ack support brace oldable with snap-lock Seat width cm , , ack support wedges Polyethylene foam, three different sizes. an be cut to desired shape H:, W:9, L:3 cm 8030 H:, W:, L:8.5 cm 839 H:.5, W:7.5, L:0 cm 840 ack support wedge ark grey plush Short 5 cm Quantity pcs Long 30 cm Quantity pcs Side cushion Provides gentle lateral support. Used when the trunk support is too stabilising. (ombined with arm support and, if necessary, side stop) Right Left Side stop Trunk support Straight or angled. ombined with wedge or side support cushion. reates a more distinct stop and holds the wedge or side support cushion in place. djustable, swing-away and detachable Straight pcs 836 Widening 5 mm pcs 837 Widening 30 mm pcs Right 84-0 Left Right Left Right Left 88-7

8 tac / ross 5 / Trunk support Settable and detachable 0 pcs pcs pcs pcs 845 Trunk support artex, fixed, adjustable in height, depth and width Quantity pcs 7395 PUR, fixed, adjustable in height, depth and width Quantity pcs 797 Trunk support PUR, swing away, adjustable in height and depth Medium Right 795- Medium Left 795- Large Right 796- Large Left 796- nti-tip Telescoping, flip-up (not with side frame ctive) 756 Settable in height and length, flip-up 577 Settable in length, flip-up nti-tip for side frame ctive Limitations: nti-tip for ross 5 ctive not with rear wheels in following positions. 0 rear wheel rear wheel 4 rear wheel 6 rear wheel ane holder Universal right 737 left 737 rey with logo Yellow with logo Spoke guard Other spoke guards see Tetra quick release adapter Quantity pcs Locking strap or a folded wheelchair 75 Toolkit 574 or sizes see loves Item no ags ellular phone holder 900 tac ox 03, nderstorp Sweden Tel ax