Quickie QRi January 2019

Transcription

1 a Mark Fr: Submitting fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Fax: ( ) Cnfirmatin Cnfirm Via: ZIP: Quickie QRi January 2019 EIR Fax Ship T Phne: ( ) Fax: ( ) a 1. FRAME STYLE & SETUP PO#: Ship T: Attentin: Address: Address: ADDITIONAL SHIPPING INFORMATION The HCPCS CODES prvided are based n cde verificatin thrugh PDAC r ur interpretatin f the cde definitins. The use f HCPCS CODES des nt ensure cverage r payment. Fr cverage infrmatin, verify the apprpriate payer's cverage plicy. Optin # HCPCS Definitin Price Optin # Ship T City: HCPCS ST: Definitin ZIP: Price Base Mdel QRi (2 lbs) 202WM81 K000 Classic Frame Style $1,89.00 E12 Applies with sizes 1" and belw Figure 1 Figure 2 202TO1 Transit Transit $ IN0 Attitude Bike (Optinal) Attitude Bike bundle See Order Frm Frame Angle (see Figure 1) 202FA FA FA2 8 Frame Inset Per Side (See Figure 2) 202FF1 0" 202FF2 1" (N/A w/ 12" wide) Frame Inset Ftrest Width 0 Subtract 0 frm Frame Width 1" Subtract 2" frm Frame Width Seat Width Measure frm utside f seat tube t utside f ppsite seat tube. 202S 12" 202S 1" 202S 1" 202S 1" 202S7 1" 202S8 17" 202S9 18" 202S10 19" 202S8 E " $00.00 Measures frm frnt f back pst t frnt edge f seat sling. Seat sling will be 1" shrter than depth rdered, but actual seat depth will remain the same as rdered. 202SD 202SD 202SD7 202SD8 202SD9 202SD10 202SD11 202SD12 202SD1 Seat Depth 12" 1" 1" 1" 1" 17" 18" 19" E220 20" $0.00 Custmer Service: Fax: rders@sunmed.cm Page 1

2 2. FRONT SEAT HEIGHT SET UP Frnt Seat Height See Figure 202SH12 1.0" 1SH20 18." 202SH1 1." 1SH " 202SH1 1.0" 1SH2 19." 202SH1 1." 1SH2 20.0" 202SH1 17.0" 202SH17 17." 202SH " Frame Depth Max Seat Squeeze 12"/1" 2." 1"/1".0" 1"/17"." 18"/19".0" 20"." Figure 202CW 202CW 202CW 202CW 202CW 202CW7 202CW 202CW 202CW 202CW8 Caster Wheels " Lw Prfile Plyurethane " x 1.2" Semi Pneumatic $.00 " x 1." Aluminum Sft Rll $18.00 " Lw Prfile Plyurethane "x 1" Aluminum Plyurethane $ "x 1." Semi Pneumatic $8.00 "x 1." Aluminum Sft Rll $19.00 " Plyurethane "x 1." Semi Pneumatic $8.00 "x 1." Aluminum Sft Rll $20.00 Frg Legs N/A w/ " casters 202CF2 202CF E CF E CF E101 Caster Frk Standard Frg Legs 0 weight t 100 lbs Frg Legs 101 lbs weight t 190 lbs Frg Legs 191 lbs weight t 2 lbs. FOOTPLATE OPTIONS Ftrest Leg strap nt included, see Ftplate Optin sectin 202F08 Aluminum 202F09 Aluminum w/ Snap n Cver 202F10 K000 Aluminum Platfrm (Ang. Adj.) 202DI19 202A DI0 202A00 K008 K008 Ftrest Optins Leg Strap $0.00 Extra Leg Strap $0.00 Psitining Plates fr Platfrm Ftrest $0.00 Gel Cver Hanger/Frame $10.00 Adaptive Platfrm Spacer N/A with Ftrest 202AD1 202AD2 202AD Adaptive Platfrm 2" Spacer Adaptive Platfrm " Spacer Adaptive Platfrm " Spacer Frame Angle Ftrest Type Platfrm Lng Platfrm and Platfrm Lng Platfrm and Platfrm Lng Platfrm and Lwer Leg Length Range Range FSH Range FSH Range 1"-17" 17."-20" Inset 0" 1" 0" 1" Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Min Max Qute r rder acknwledgement will display standard r lng ftrest used with cnfiguratin f chair. Subtract apprpriate length if using platfrm spacers. and Platfrm Ftrest Caster/Frk Availability Caster Frk Inset 0" 1" Standard Frk Frg Legs Standard Frk Frg Legs Standard Frk Frg Legs Standard Frk Frg Legs N/A N/A Standard Frk Frg Legs Standard Frk Frg Legs Standard Frk Frg Legs N/A Standard Frk N/A w/1. Frg Legs N/A N/A Standard Frk Frg Legs N/A Standard Frk Frg Legs N/A N/A w/1. Standard Frk N/A w/1. Frg Legs N/A N/A Standard Frk N/A N/A Frg Legs N/A N/A N/A w/ 1. = N/A with the 1." wide caster. Blank = available. N G's may still apply that are nt listed based n actual cnfiguratin f the chair. 7 Frame Angle 80 Frame Angle 8 Frame Angle Custmer Service: Fax: rders@sunmed.cm Page 2

3 Rear Seat Height Rear Tire & Wheel Matrix 1" and 1." nly availble w/ 22" rear wheels 202RH1 1.0" Wheel Ultra Mag Lite Spke 202RH1 1." Tire Lightweight Spinergy 202RH1 202RH1 202RH17 1.0" 1." 1.0" Pneumatic Pneumatic w/ Airless Insert Full Ply 22,2 22,2 22,2 22,2,2 22,2 22,2 22,2,2 22,2,2 202RH18 202RH19 202RH2 1." 17.0" 17." High-Pressure Clincher Knbby V Trak by Kenda Schwalbe Marathn 22,2,2,2 2,2,2 22,2,2 22,2,2,2 2 2,2,2 202RH " SHOX Perfrmance Ply 2 2,2 2,2 202RH27 202RH21 202RH7 18." 19.0" 19." 22" = 89 2" = 0 2" = 9 2" = RH " Handrim Plastic nt available n all wheels in all sizes. Natural Fits are N/A w/ 2" Rear Wheel Size 202HR1 Aluminum Andized Ultra Lightweight Wheels nly available with aluminum anndized handrim 202HR Plastic Cntact Built Me fr Spinergy clr ptins 202HR22 Natural Fit - Standard Grip $ RW8 22" Mag Wheel 202HR2 Natural Fit - Super Grip 202RW1 2" Mag Wheel 202HR0 Natural Fit LT - Standard Grip $ RW91 22" Lite Spke Wheel $ HR1 Natural Fit LT - Super Grip $ RW92 202RW9 2" Lite Spke Wheel 2" Lite Spke Wheel Center f Gravity Preset 202RW9 2" Lite Spke Wheel $80.00 Measure frm frnt f back pst t center f rear axle 202RW0 22" Ultra Lightweight Spke Wheel 2.0 $ CC2 1.0" 202RW10 2" Ultra Lightweight Spke Wheel 2.0 $ CC 1." 202RW1 2" Ultra Lightweight Spke Wheel 2.0 $ CC 2.0" 202RW28 22" Spinergy SPOX Black $ CC 2." 202RW9 2" Spinergy SPOX Black $ CC.0" 202RW9 2" Spinergy SPOX Black $ RW97 2" Spinergy SPOX Black $8.00 Camber 202RW2 22" Spinergy LX Black $1, CI RW98 2" Spinergy LX Black $1, CI2 202RW99 2" Spinergy LX Black $1, RW0 2" Spinergy LX Black $1,00.00 Axle 202AX1 Quick Release Steel Rear Wheel Tire Quad Quick Release 202AX1 See Availability Matrix Only available with Mag wheels $ RT2 202RT1 202RT 202RT 202RT27 202RT21 202RT8 E221 E2218 Rear Seat t Flr Height Pneumatic Pneumatic w/ Airless Insert Full Ply High-Pressure Clincher Knbby V- Trak Schwalbe Marathn Plus Evlutin SHOX Perfrmance Ply Shrt Axle Plate/Wheel Size Matrix 22" 2" 2" " REAR SEAT HEIGHT SET UP $8.00 $10.00 Axle Plates See Shrt Axle Plate Matrix fr RSH Availability 202AL0 Standard Shrt (COG 1" t ") 202AL Standard Lng (COG 1" t ") Wheel Lck Nt all wheel lcks available in all seat depths, wheel sizes and COG settings 202WL1 202WL2 202WL High Munt Push High Munt Pull Erg Scissr 202WL0 Cmpact $ WL10 Omit Wheel Lck 202WL12 D Nt Munt Extensin Handle Only available w/ High Munt Push r Pull Wheel Lcks 202EH7 E091 Extensin handles (Pair) $7.00 Custmer Service: Fax: rders@sunmed.cm Page

4 . ARMREST Preset t 10". Sme limitatins may exist with integral and flding push handles Range 9"-1". 202AA18 E097 Padded Swing-Away - Standard $ AA11 202AA29 Armrest - Padded Swing Away Armrest - Height Adjustable E097 Single Pst Ht. Adjust. Std (8."-1.") $28.00 E097 Single Pst Ht. Adjust. Lw (7"-11") $ AM2 202AM2 202AA1 2028A0 Armpad - Fr Height Adjustable Desk Length - Classic (10") Full Length - Classic (1") Omit Armrest Omit Armrest Armrest Accessries Gel Cver Swing Away Arm $ BACKREST Back Type JAY J Back 202BT82 Flding Lck Dwn Angle Adj 202JB01 JAY J Back See OF 202BT Nn-Flding Backrest Military Service Patches Push Handles Only available n tensin adjustable uphlstery and Jay Back 202PH Integral Push Handles 202VU1 US Marines Patch 202PH Fld-Dwn Push Handles N/A w/ VU2 US Army Patch $ " Back Height r Standard Uphlstery. 202VU US Navy Patch 202PH2 Omit Push Handles 202VU US Air Frce Patch 202VU12 US Cast Guard Height Adjustable Backrest 202VU Purple Heart 202B110 10" - 1" Back Height 202VU8 Purple Heart with Marines Patch $ B127 12" - 1" Back Height 202VU9 Purple Heart with Army Patch $ B111 1" - 18" Back Height 202VU10 Purple Heart with Navy Patch $ B17 1" - 20" Back Height 202VU11 202VU1 Purple Heart with Air Frce Patch Purple Heart with Cast Guard $1.00 $1.00 Back Uphlstery 202BU1 Standard Uphlstery 202BU70 E211 Backrest Tensin Adj Ballistic Nyln *reference 18BU70 fr billing $ BU71 E211 Backrest Tensin Adj DX Vented *reference 18BU71 fr billing $ BU1 Omit Uphlstery (Use w/ JAY Backs) -$ SEATING 202SL1 202SL Seat Sling Standard Seat Sling Omit Seat Sling -$1.00 JAY Cushins (Optinal) T rder any JAY cushins n-chair, please see the JAY price list. Cushin name r part number must be filled ut with desired width and depth JAY Bundled Cushin 202JC20 Cushin Name r Part # Price List Width: Depth: Custmer Service: Fax: rders@sunmed.cm Page

5 8. Key Optins & Accessries 202AT1 202AT 202SG 202SG29 202SG 202SG E0971 Anti Tips Anti Tips (Pair) Omit Rear Anti Tip $10.00 Side Guards Plastic - Standard (8." High) $1.00 Plastic - Lw (." High) $1.00 Aluminum N/A w/ height adj arms, push/pull wheel lcks nly available in black Aluminum w/ Fender adj arms, push/pull wheel lcks nly available in black N/A w/ height $2.00 $ A1 202A2 202A8 202A12 202A A02 202A2 Pack Accessries Quickie Backpack Black Quickie Kids Backpack Black Seat Puch Black Psitining Belt E " Aut Buckle Universal w/clamps Psitining Belt Slide Clamps $7.00 $0.00 $0.00 $70.00 $0.00 Spke Guards K00 Quickie Clear Spke Guard $11.00 K00 Quickie Black Spke Guard $11.00 Miscellaneus 202DI07 Neprene Impact Guards 202A2100 E A8 202A8 Crutch Hlder Only available with $19.00 Integral r Fld Dwn push handles Blt-On Push Handles $11.00 Tl Kit $ COLOR Standard Frame Clrs Matte Frame Clrs 202C10 Aztec Gld 202C11 Matte Black 202C2 Black (Nt avail as base w/zebra) 202C11 Matte Black Cherry 202C11 Black Cherry 202C10 Matte Electric Blue 202C10 Black Opal 202C19 Matte Evergreen 202C8 Blue Opal 202C12 Matte Purple 202C Candy Blue 202C1 Candy Purple Custm Frame Clr 202C Candy Red 202C112 Desert Camuflage $ C12 Electric Blue 202C Mssy Oak Camuflage $ C1 Evergreen 202C2 Stars & Stripes $ C12 Glw Zebra (Chse abve base clr) Std with White unless abve base paint is 202C1 Green Apple 202C108 chsen N/A w/ Blk, Matte Black, Blk Opal, 202C17 Ht Sparkle Pink Titanium) $ C18 Mauve Pink 202C10 Rtbeer 202C11 Sparkle Silver Additinal Optins Thrugh Built fr Me 202C1 Sunrise Orange T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800) - 000, Fax: (800) C11 Titanium Clr Paint 202C8 Yellw Sunrise Medical (US) LLC 282 Business Park Ave. Fresn, CA 9727 USA Custmer Service: Fax: rders@sunmed.cm Page