Quickie Q7 Adjustable November 2012

Transcription

1 a Mark Submitting Fr: fr: Qute Order Dealer Acct #: ST: Dealer Phne: ( ) Address: Fax: ( ) ZIP: Cnfirmatin Ship T City: ST: Cnfirm Via: Fax Ship T Phne: ( ) Fax: ( ) Optin # Date: Dealer: Dealer Cntact: Dealer Address: Dealer City: HCPCS a Ship T: Quickie Q7 Adjustable Nvember 2012 Price EIR4 Optin # 1. FRAME STYLE & SETUP PO#: Attentin: Address: HCPCS Definitin 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. Definitin ZIP: Price 186WM60 Base Mdel Quickie Q7 - Adjustable (265 ) K0005 Pwer assist NA n the Q7 $2, Perfrmance Package (N substitutins, discunt given n separate line) 186QD01 Single Sided Frk Ultra Lightweight Wheel Schwalbe Marathn Plus Evlutin Cmpact Wheel Lck Retail Value $ Package Price $ Ultra Lite Package (N substitutins, discunt given n separate line) 186QD02 Ultra Lite Seat Sling $10 Ultra Lightweight Wheel Schwalbe Speed Run Tire Cmpact Wheel Lck Retail Value $60 Package Price $51 Frame Angle See FIGURE 1 Measure frm frnt frame t flr. 186FA1 186FA8 186FA See FIGURE 2 Frame Inset is the distance frm the utside f the seat tube t the utside f the ftrest. 186FF1 186FF2 0" 1" (NA w/ 12" wide) 186FF3 2" (NA with 12" & 13" wide) Frame Style See FIGURE 3 Measurement fr set up 186FS9 Standard 186FS34 Classic * Standard Frame - Seat Sling t frnt frame bend angle is 1.5" shrter than the classic psitin. Classic Frame - Traditinal GT seat sling t frnt frame bend angle dimensins. Frnt f back cane pst t frnt edge f seat sling will remain the same fr bth Standard and Classic. See FIGURE 4 186LH01 Frame Inset Per Side Caster Husing Psitin 1 Suggested fr 3" & 4" casters. Fr 2" Inset all casters use 2 186LH02 2 Suggested fr 5" & 6" casters. Frame - Direct Munt Wheel Lck (Optinal) N munting clamp hardware. Only available with Cmpact Wheel Lck and 0 Camber. Nt available with muntain tires r rear suspensin. Traditinal wheel lcks available, see page 5. NA with rear suspensin system. 186WH13 Figure 1 Figure 2 Figure 3 Figure 4 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev K Page 1

2 1. FRAME STYLE & SETUP (CONT.) Depth Adjustable Backrest (Optinal) See Figure 5 Depth Adjust Backrest extends the frame rear f the seat sling, select a factry setting. 0 Backrest at standard 186DP02 $ Figure 6 Figure 7 psitin, field adjustable t -1" r -2" 186DP03 186DP04-1 Backrest -1" ffset, field adjustable t flush r -2" $ Backrest -2" ffset, field adjustable t flush r -1" $ Figure 5 186OP01 Seating Systems Standard Seat Sling Ultra Seat Sling 186OP02 Available t 18" Width and Depth. Ultra Seat Sling will be ~1/4" less than requested seat height value. 186OP04 Omit Seat Sling $10 Seat Width See FIGURE 6 Measure frm utside f seat tube t the utside f ppsite seat tube. 186S3 186S4 186S5 186S6 186S7 12" 13" 15" 16" 186S8 186S9 186S10 186S48 17" 18" 19" 20" (E2201) $45 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 186JC20 Cushin Name r Part # Price List Width: Depth: Seat Depth See FIGURE 7 Measure frm frnt f back pst t frnt edge f seat sling. Seat sling is 1" shrter than depth rdered, but actual seat depth will remain the same as rdered. 186SD5 186SD6 186SD7 186SD8 186SD9 12" 13" 15" 16" 186SD10 186SD11 186SD12 186SD13 17" 18" 19" 20" (E2203) $ FRONT SEAT HEIGHT SET UP Frnt Seat Height See FIGURE 8 Measure frm the frnt f the seat rail t the flr. 186SH " 186SH " 186SH " 186SH " 186SH " 186SH " 186SH " 186SH 20.0" 186SH " 186SH " 186SH " Figure 8 186CW1 186CW3 186CW31 186CW72 186CW44 186CW64 186CW5 186CW51 186CW6 186CW65 186CW7 186CW66 186CW34 186CW33 Caster Wheels 3" Micr 4" Lw Prfile Plyurethane 4" Micr Lighted 4" x 1" Aluminum Ply 4" x 1.25 Semi 4" x 1.5" Aluminum Sft Rll 5" Lw Prfile Plyurethane 5" Micr Lighted 5" Sft Rll (Grey) -NA w/frg Legs 5" x 1" Aluminum Ply 5" x 1.5" Semi 5" x 1.5" Aluminum Sft Rll 6" Ply $7 $55.00 $ $10 186CW35 186CW68 E2214 6" E2215 6" x 1.5" Semi 6" x 1.5" Aluminum Sft Rll $16 186CF65 186CF69 186CF53 186CF54 186CF55 Caster Frks and Suspensin Multiple Psitin Multiple Psitin Single Sided Frk E1015 Frg Legs 0 weight t 100. E1015 Frg Legs 101. weight t 190. E1015 Frg Legs 191. weight t 265. Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev K Page 2

3 3. FOOTPLATE OPTIONS 186F F F F51 Ftrest Aluminum Tubular Aluminum Tubular w/ Snap On Cver K0040 Angle Adjustable Flip Back K0040 Platfrm Ftrest $3 $ F111 Ultra Lite Platfrm Ftrest K0040 NA w/ wide and 2" inset, NA w/ $ DI03 186DI04 186DI05 186DI07 186DI02 186DI06 Ftrest Optins K0038 Leg Strap K0038 Extra Leg Strap Gel Hanger Cver Neprene Impact Guards Wear Pads Psitin Plates (NA fr Tubular Ftrest) 186BT3 Nn-Flding Angle Adjustable $35.00 $35.00 $ wide w/ 0" inset Adaptive Platfrm Spacer Only available with Platfrm Ftrest. NA w/ Ultra Lite Platfrm. 186AD1 Adaptive Platfrm 2" Spacer 186AD2 Adaptive Platfrm 4" Spacer 186AD3 Adaptive Platfrm 6" Spacer 4. BACKREST 186BT96 Back Type Flding Angle Adj w/duble Lck Dwn Chse Optin 1 r 2 186QT01 186QT02 186PH6 186PH5 186PH2 186BU1 186BU70 186BU71 186BU14 Twel Bar Standard Style - 4" Offset Lw Prfile - 2" Offset Limited w/slid Backs, Nt suggested with 19" & 20" wide Backrest Handles Integral Push Handles Fld Dwn Push Handles NA w/ 10" adj height & 8"-10" fixed height NA w/ standard uphlstery Omit Push Handles Backrest Uphlstery Standard Uphlstery E2611 Backrest Tensin Adj Ballistic Nyln E2611 Backrest Tensin Adj 3DX Vented Omit Back Uphlstery $10 OR 1. Aluminum Height Adjustable Backrest 10 "- Back Height "- 16" Back Height "- 18" Back Height "- 20" Back Height Ultra Lightweight Aluminum Fixed Backrest Select back height. 8", 9", r 10" nly available mit push handles. 17", 18", r 19" nly available with fld dwn push handles 186BB21 8" 186BB17 186BB20 9" 186BB18 15" 186BB13 10" 186BB19 16" 186BB14 11" 186BB10 17" 186BB15 12" 186BB11 18" 186BB16 13" 186BB12 19" Military Service Patches Only available n tensin adjustable uphlstery and Jay 3 Back 186VU1 US Marines Patch 186VU2 US Army Patch 186VU3 US Navy Patch 186VU4 US Air Frce Patch 186VU12 Cast Guard Patch 186VU5 Purple Heart 186VU8 Purple Heart with Marines Patch 186VU9 Purple Heart with Army Patch 186VU10 Purple Heart with Navy Patch 186VU11 Purple Heart with Air Frce Patch Backrest Optins $ $33 -$15.00 JAY J3 Back Narrw Backrest Inset Backcanes 1" 186OD5 186A192 narrwer than selected seat width. NA with 12" Wide. NA w/ Aluminum r Carbn Side Guards Telescping Push Handles Range f 13-19" frm sling t handle $ J3 Back 186JB01 T rder a J3 Back please select Omit Back Uphlstery. See J3 Back Order Frm fr Part #'s. Price List 5. REAR SEAT HEIGHT SET UP Axle Plate Adjustable COG (1"-4") Rear Suspensin (Optinal) 4-Link Rear Suspensin COG (0"-3") Single Pst nly available up t 2" COG. Plastic Side Guards nly available up t 2.5" COG $ SV08 Weight frm 0 t 175 $ SV09 Weight frm 176. t 265 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev K Page 3

4 5. REAR SEAT HEIGHT SET UP (CONT) Center f Gravity Preset Measure frm frnt f back pst t the center f rear axle. 0" (Rear Suspensin System Only) 186CC12.5" (Rear Suspensin System Only 186CC1 1.0" 186CC2 1.5" 186CC3 2.0" 186CC4 2.5" 186CC5 3.0" 186CC6 3.5" (NA w/ Suspensin) 186CC7 4.0" (NA w/ Suspensin) 186CC8 Camber (NA w/ Mag wheel) 186CI1 186CI2 186CI4 Frnt t Rear Seat Height Matrix 12" Seat Depth 2.5" Max Frnt t Rear Seat Hgt. 13", Seat Depth 3.0" Max Frnt t Rear Seat Hgt. 15", 16" Seat Depth 3.5" Max Frnt t Rear Seat Hgt. 17", 18" Seat Depth 4.0" Max Frnt t Rear Seat Hgt. 19", 20" Seat Depth 4.5" Max Frnt t Rear Seat Hgt. 186RH11 186RH12 186RH13 186RH14 186RH15 186RH16 186RH17 186RH18 186RH19 186RH26 186RH20 186RH27 186RH21 186RH37 186RH22 Wheel Tire Full Ply Tire High Pressure Clincher Kik Mak Black Knbby V-TRAK w/airless Insert Schwalbe Marathn Schwalbe Speed Run 22" = 489 mm Rear Seat Height 13.0" Only w/ 20" Rear Wheel. NA w/ Rear Suspensin 13.5" Only w/ 20" Rear Wheel. NA w/ Rear Suspensin 14.0" Only w/ 20" Rear Wheel. 14.5" Only w/ 20" Rear Wheel. 15.0" Only w/ 20" r 22" Rear Wheel fr Adjustable Axle. Only w/ 20" Rear Wheel fr Rear Suspensin 15.5" Only w/ 20" r 22" r " w/hp Clincher Rear Wheel. Only w/ 20" Rear Wheel fr Rear Suspensin 16.0" NA w/, 25 & 26" Rear Wheels and Rear Suspensin 16.5" NA w/, 25 & 26" Rear Wheels and Rear Suspensin 17.0" 17.5" 18.0" 18.5" 19.0" 19.5" 20.0" NA w/ Rear Suspensin Mag Lite Spke 186AX13 Spinergy 22,,25 22,,25,26,25,25,26 22,,26,26,25,26 22,,25,25,26,25,25,25 22,,26 Axle Quick Release Steel Quad Quick Release Steel Only available with Mag Wheels Rear Wheel Ultra Lightweight nly available w/ Aluminum Handrim. Pwer assist nt available n the Q7. Cntact Built 4 Me fr Spinergy clr ptins. 20" Mag 186RW3 22" Mag 186RW8 " Mag 186RW1 20" Lite Spke 186RW90 22" Lite Spke 186RW91 " Lite Spke 186RW92 25" Lite Spke 186RW93 26" Lite Spke 186RW94 22" Ultra Lightweight Spke RW06 " Ultra Lightweight Spke RW10 25" Ultra Lightweight Spke RW16 22" Spinergy SPOX Black Spkes 186RW28 " Spinergy SPOX Black Spkes 186RW95 25" Spinergy SPOX Black Spkes 186RW96 26" Spinergy SPOX Black Spkes 186RW97 22" Spinergy LX Black Spkes 186RW32 " Spinergy LX Black Spkes 186RW98 25" Spinergy LX Black Spkes 186RW99 26" Spinergy LX Black Spkes 186RW40 " Muntain 186RW50 186RT3 186RT6 186RT22 186RT27 186RT12 186RT1 186RT2 186RT21 186RT28 Ultra Lightweight " = 540 mm 25" = " = AX1 22,,25,26 E2218 E2218 E2213 Rear Wheel Tire Full Ply Tire High-Pressure Clincher Kik Mak Black $20 $20 Knbby V-TRAK by Kenda Muntain Only available in " Airless Insert Schwalbe Marathn Plus Evlutin Schwalbe Speed Run Tire Handrim Natural Fit Handrims nly available in 22", ", & 25" Aluminum Andized 186HR1 Plastic Cated NA w/ 25" & 26" 186HR4 Lite Spke Wheels Natural Fit - Standard Grip 186HR22 Natural Fit - Super Grip 186HR23 Natural Fit LT - Standard Grip 186HR30 Natural Fit LT - Super Grip 186HR31 Spinergy Flex Rim Only available 186HR n Spinergy LX wheels " & 25" Omit Handrim 186HR7 NA w/ Ultra Lightweight Wheels Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev K Page 4 $ $ $525.00

5 5. ARMREST Armrest - Padded Swing Away Sme limitatins when used with the Angle Adjustable Back in the rear mst setting Please select a setting, will default t 11" if n selectin is made 186AA18 E0973 Padded Swing-Away STD (9" t ) 9" 10" 11" 12" 13" 186AA11 Armrest - Height Adjustable Single Pst Height Adjustable - Std E AA29 E0973 $ $26 Range 8" - 13". Adjust in 1" increments Single Pst Height Adjustable - Lw Range 6.5" ". Adjust in 1" increments 186AM23 186AM21 186AM 186AM22 186NP01 Armpad - Fr Height Adjustable Desk Length (10") Classic Desk Length (10") Cntur Full Length () Classic Full Length () Cntur Armrest Optins Gel Swing Away Pad $ $26 6. KEY OPTIONS & ACCESSORIES Wheel Lck Nt all wheel lcks available in all seat depths, wheel size, r COG 186WL1 High Munt Push 186WL2 High Munt Pull 186WL45 Erg Scissr 186WL30 Cmpact 186WL10 Omit Wheel Lck Wheel Lck Optins D Nt Munt 186WL12 Extensin Handle Ext. handles nly available with high munt push r pull wheel lcks E0961 Extensin Handle (Pair) 186EH7 186AT37 Anti Tips E0971 Anti Tips (Pair) $6 $ Side Guards Increases verall width f chair. Sme interferance my exist w/ padded SA arms at lwest settings Plastic Standard 186SG33 NA w/ Height Adjustable Arms Plastic Lw 186SG29 NA w/ Height Adjustable Arms Aluminum NA w/height Adj. Arms, High 186SG35 $ A A83 186C C2 186C10 186C38 186C36 186C14 186C35 186C C6 186C C C C C4 186C5 186C C C C11 186C8 Frame Clr Bead Blast Black Black Opal Blue Opal Candy Blue Candy Purple Candy Red Cpper Frest Green Fuchsia Glw Matte Black Matte Green Midnight Purple Pearl Pink Rtbeer Sparkle Silver Titanium Clr Paint Txic Green Yellw 186C C43 186C42 Custm Frame Clr Desert Camuflage Mssy Oak Camuflage Stars & Stripes 186C108 Push r Pull Wheel Lcks 186SG36 Aluminum w/ Fender NA w/ Height Adj. 186SG12 Arms, High Push r Pull Wheel Lcks Carbn Fiber NA w/ Height Adj. Arms, High Push r Pull Wheel Lcks Side Guard - Clr Optin Available with Aluminum r Aluminum with Fender. 186GE01 Black 186GE02 Matching Frame- Standard Clrs 186GE03 Matching Frame- Custm Clr $5.00 $45 186A A A141 Psitining Belt E0978 Belt 2" Aircraft Buckle w/clamps E0978 Belt 2" Aircraft Buckle Padded w/clamps E0978 Belt 1.5" Aut Buckle Universal w/clamps $11 $12 $7 186A23 186A302 Spke Guards K0065 Black Spke Guard K0065 Quickie "Q" Clear $ $ A1 186A2 186A8 Additinal Pack Accessries Backpack - Adult Backpack - Kids Black Seat Puch Miscellaneus E2207 Crutch Hlder Tl Kit $ $45.00 Zebra (Chse abve base clr) Std with White unless abve base paint is chsen NA w/ Black Andized Clr Package Frks, Backcane Bracket, Rear Axle Clamp. NA w/ Frg Legs- andized parts can be rdered separately 186EB07 Black 186EB08 Blue 186EB09 Green 186EB10 Purple 186EB11 Red 186EB12 Ti Grey Built Fr Me T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800) , Optin #3, Fax: (800) $55.00 $45.00 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev K Page 5

6 7. APPENDIX Base Chair Includes: BASE CHAIR WEIGHTS DEPTH WIDTH Frnt Caster 4" Lw Prfile Ply Frk Lw Narrw Caster Blt Caster Stem Shrt (1.75") Ft Rest Aluminum Tubular Rear Wheel " Lite Spke Wheel Tire Handrim Aluminum Andized Backrest Shrt 2" Twel Bar Backrest UPH Standard Seat Sling Standard Pushhandles Omit Push Handle 12"-16" Wheel Lck Erg Scissr **Weights are prvided as a guideline, actual can vary because f sizing, manufacturing, r material variances. Example 20" tire vs. ". **Nt all frame set up r ptins are listed Cm pnent Cm pnent Standard Seat Sling Ultra Seat Sling Omit Seat Sling Seat Cushin DAB With Padded S/A Armrest With Out Padded S/A Armrest Backrest w ith Tw el Bar 4" Tw el Bar 2" Cushin 1.26 Adj Height BackRest 10-14,12-16,14-18 Muntain Tire 1.54 Grade Aid Hardw are Omit Cushin Adj Height BackRest Direct Munt " Fixed Height Backrest Airless Insert 2.00 Omit Wheel Lck " Fixed Height Backrest Schw albe Marathn Plus Evlutin 0.34 Schw albe Speed Run Seat Sling Caster Wheels (Pair) 3" Micr Cm pnent Cm pnent Rear Tires (Pair) Full Ply High-Pressure Clincher Kik Mak Black Knbby V-Trak by Kenda Wheel Lck (Pair) Push Wheel Lck Pull Wheel Lck Erg Scissr Cmpact Wheel Lck Wheel Lck Extensin Handle 4" Lw Prfile Ply 10" Fixed Height Backrest " Micr Lighted " Fixed Height Backrest " Pair 4" x 1" Aluminum Ply " Fixed Height Backrest Aluminum Andized Anti-tip " Wheel 4" x 1.25" Semi Pneu " Fixed Height Backrest Aluminum - Ultra Wheel Only Omit Anti-Tips 4 x 1.5" Aluminum Sft Rll 0.57 Fixed Height Backrest Plastic Cated 1.60 Handrim s (Pair) 0.10 Rear Anti-tip 1.03 Side Guard 5" Lw Prfile Ply " Fixed Height Backrest 0.01 Natural Fit Standard Grip 1.95 Plastic Side Guard Lw " Micr Lighted " Fixed Height Backrest 0.04 Natural Fit Super Grip 1.95 Plastic Side Guard Standard " Sf t Rll Semi Pneu " Fixed Height Backrest 0.06 Natural Fit LT Standard Grip 1.57 Carbn 5" x 1" Aluminum Ply " Fixed Height Backrest 0.08 Natrual Fit LT Super Grip 1.57 Aluminum Side Guard " x 1.5" Semi Pneu " Fixed Height Backrest 0.11 Aluminum Side Guard w ith Fender " x 1.5" Aluminum Sf t rll 1.04 Active Rigid Backrest " Ply " x 1.5" Semi Pneu 0.88 Tensin Ballistic "x 1.5" Aluminum Sft Rll 1.35 Tensin Vented " 0.55 Standard Desk Length - Classic Omit Uphlstery Caster Frks (Pair) Backrest UPH Arm rests (Pair) Padded S/A Assembly 2.97 SPHA Standard 4.33 Backpack 0.45 SPHA Lw 3.76 Backpack Kids 0.25 Black Seat Puch Belt 2" Aircraf t Buckle 0.44 Desk Length - Cntur 1.14 Belt 2" Aircraf t Buckle Padded 0.60 Full Length - Classic 2.73 Belt 1.5" Aut Buckle Universal 0.38 Full Length - Cntur 1.50 Arm rest Pads (Pair) Accessries Lw Narrw Lw Wide 0.07 Integral Push Handles Shrt 0.10 Lw Single Sided 0.02 Integral Push Handles Medium 0.17 Standard Narrw 0.04 Integral Push Handles Tall 0. 20" Mag Wheel Standard Wide 0.12 Fld-Dw n Push Handles 12-16, " Mag Wheel Standard Single Sided 0.09 Fld-Dw n Push Handles " Mag Wheel 1.78 Frg Legs 0.62 Omit Push Handle " Lite Spke Wheel Quick Release (Light Spke Wheel) Omit Push Handle " Lite Spke Wheel Quick Release (Spinergy, Ultra-Light) 0.03 Omit Push Handle " Lite Spke Wheel Quick Release (Mag Wheels) Quad Quick Release 0.13 Ftrest Aluminum Tubular Push Handles (Pair) Crutch Hlder 0.57 Gel Cver Armrest Pad Neprene Impact Guards Wheelchair Tray 6.50 Rear Wheel (Pair) Aluminum Tubular Lng 0.06 Omit Push Handle " Lite Spke Wheel 0.07 Aluminum Platfrm 1.07 N Push Handles " Lite Spke Wheel 0.27 Aluminum Platfrm Lng " Ultra Lightw eight Spke Wheel Ultra Lite Aluminum Ftrest 0.36 N Leg Strap " Ultra Lightw eight Spke Wheel Ultra Lite Aluminum Ftrest Lng 0.41 Leg Strap (10-) " Ultra Lightw eight Spke Wheel Leg Strap (15-17") 25" Ultra Lightw eight Spke Wheel Leg Strap (18-20") 0.01 " Spinergy SPOX Black " Spinergy SPOX Black 0.15 Ftrest Optins Leg Strap Remvable Snap On Cver (16" Wide) 0. Wear Pads (ea) Need 2 per chair 0.02 Adaptive Platfrm 2" Spacer 0.16 Angle Adj. Flding Lck Dw n Back 26" Spinergy SPOX Black 0.43 Adaptive Platfrm 4" Spacer 0.34 Nn-Flding Backrest " Spinergy LX Black Adaptive Platfrm 6" Spacer 0.52 " Muntain (Uses a 22" Rim) 2.97 Psitin Plate fr Aluminum Ftrest 1.04 N Ft Rest Optins Back Type Axles (Pair) Suspensin 4- Link Suspensin Assembly Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 April 2012, Rev K Page