Quickie Q7 Active Rigid November 2012

Transcription

1 a Mark Submitting Fr: fr: Qute Order Date: Dealer Acct #: Dealer: Dealer Cntact: Dealer Address: Dealer City: ST: Dealer Phne: ( ) Address: Fax: ( ) Cnfirmatin Cnfirm Via: PO#: Quickie Q7 Active Rigid Nvember 2012 ZIP: EIR4 Attentin: Address: Fax Ship T Phne: ( ) Fax: ( ) 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 a Definitin Price Optin # HCPCS 1. FRAME STYLE & SETUP Ship T: Ship T City: ST: ADDITIONAL SHIPPING INFORMATION Definitin ZIP: Price 186WM61 Base Mdel Quickie Q7 - Welded (265 lbs) K0009 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 $ Ultra Lightweight Wheel Schwalbe Speed Run Tire Cmpact Wheel Lck Retail Value $ Package Price $ 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 Setting 1 Suggested fr 3" & 4" casters. Fr 2" Inset all casters use Setting 2 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 Direct Munt Wheel Lck Setting 2 Suggested fr 5" & 6" casters. 186LH02 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 Rigid April 2012, Rev G Page 1

2 1. FRAME STYLE & SETUP (CONT.) Seat Width See FIGURE 6 Measure frm utside f seat tube t the utside f ppsite seat tube. 186S3 12" 186S8 17" 186S4 13" 186S9 18" 186S5 14" 186S10 19" 186S6 15" 20" 186S48 $ S7 16" (E2201) Seating Systems 186OP01 Standard Seat Sling 186OP02 186OP04 Ultra Seat Sling Available 14" t 18" Width and Depth. Ultra Seat Sling will be ~1/4" less than requested seat height value. Omit Seat Sling $ Seat Depth See FIGURE 7 Measure frm frnt f back pst t frnt edge f seat sling. Seat sling is 1" JAY Cushins (Optinal) shrter than depth rdered, but actual seat depth will remain the same as rdered. T rder any JAY cushins n-chair, please see the JAY price list. 186SD5 12" 186SD10 17" Cushin name r part number must be filled ut with desired width and depth 186SD6 13" 186SD11 18" JAY Bundled Cushin 186SD7 14" 186SD12 19" 186JC20 Cushin Name r Part # Price List 186SD8 15" 20" Width: Depth: 186SD13 $ SD9 16" (E2203) Figure 6 Figure 7 2. 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 " 186SH " 186SH " 186SH " Figure 8 186CW1 186CW3 186CW31 186CW72 186CW44 186CW64 186CW5 186CW51 186CW6 186CW65 186CW66 186CW34 E2214 E2215 Caster Wheels 3" Micr 4" Lw Prfile Plyurethane 4" Micr Lighted $ " x 1" Aluminum Ply $ " x 1.25 Semi Pneumatic $ " x 1.5" Aluminum Sft Rll $ " Lw Prfile Plyurethane 5" Micr Lighted $ " Sft Rll (Grey) -NA w/frg Legs $ " x 1" Aluminum Ply $ " x 1.5" Semi Pneumatic $ CW7 5" x 1.5" Aluminum Sft Rll $ " Ply 6" Pneumatic 186CW33 $ CW35 6" x 1.5" Semi Pneumatic $ CW68 6" x 1.5" Aluminum Sft Rll $ Caster Frks and Suspensin 186CF65 Multiple Psitin 186CF69 Multiple Psitin Single Sided Frk 186CF53 E1015 Frg Legs 0 weight t 100 lbs. $ CF54 E1015 Frg Legs 101 lbs. weight t 190 lbs. $ CF55 E1015 Frg Legs 191 lbs. weight t 265 lbs. $ Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 Rigid April 2012, Rev G Page 2

3 3. FOOTPLATE OPTIONS Ftrest Ftrest Optins 186F229 Aluminum Tubular K0038 Leg Strap $ DI03 Aluminum Tubular w/ Snap On Cver 186F DI04 K0038 Extra Leg Strap $30.00 $ F276 K0040 $ DI05 Angle Adjustable Flip Gel Back Hanger Cver $ F51 K0040 Platfrm Ftrest 186DI07 Neprene Impact Guards $85.00 Ultra Lite Platfrm Ftrest 186DI02 Wear Pads $50.00 K0040 NA w/ 14" wide and 2" inset, NA w/ $ F DI06 Psitin Plates (NA fr Tubular Ftrest) $50.00 wide w/ 0" inset Adaptive Platfrm Spacer Only available with Platfrm Ftrest. NA w/ Ultra Lite Platfrm. 186AD1 186AD2 Adaptive Platfrm 2" Spacer Adaptive Platfrm 4" Spacer 186AD3 4. BACKREST Adaptive Platfrm 6" Spacer Back Type See FIGURE 9 Chse backrest psitin. 0 Equal is perpindicular t flr, + means frward 186PH5 Active Fixed Backrest 186BT97 Setting PH2 Backrest Handles Fld Dwn Push Handles NA w/ 8"- 10" fixed height NA w/ standard uphlstery Omit Push Handles $ Figure 9 Backrest Uphlstery 186BU1 Standard Uphlstery 186BU70 E2611 Backrest Tensin Adj Ballistic Nyln $ BU71 E2611 Backrest Tensin Adj 3DX Vented $ BU14 Omit Back Uphlstery -$ JB01 JAY J3 Back J3 Back T rder a J3 Back please select Omit Back Uphlstery. See J3 Back Order Frm fr Part #'s. Price List Ultra Lightweight Aluminum Fixed Backrest Select back height. 8", 9", r 10" nly available mit push handles. Military Service Patches 17", 18", r 19" nly available with fld dwn push handles Only available n tensin adjustable uphlstery and Jay 3 Back 186BB21 8" $ BB17 14" $ VU1 US Marines Patch $ BB20 9" $ BB18 15" $ VU2 US Army Patch $ BB13 10" $ BB19 16" $ VU3 US Navy Patch $ BB14 11" $ BB10 17" $ VU4 US Air Frce Patch $ BB15 12" $ BB11 18" $ VU12 Cast Guard Patch $ BB16 13" $ BB12 19" $ VU5 186VU8 Purple Heart Purple Heart with Marines Patch $90.00 $ Twel Bar 186VU9 Purple Heart with Army Patch $ QT01 Standard Style - 4" Offset 186VU10 Purple Heart with Navy Patch $ Lw Prfile - 2" Offset Limited 186VU11 Purple Heart with Air Frce Patch $ QT02 w/slid Backs, Nt suggested with $ " & 20" wide 5. REAR SEAT HEIGHT SET UP 186AL57 Axle Plate Active Rigid (.5" t 4") Adjustment range 1/2" fre and aft in 1/4" increments except the.5" and 4" psitins which are maxed Measure frm frnt f back pst t the center f rear axle. N additinal rearward adjustment when.5" chsen. N additinal frward adjustment when 4" chsen. Center f Gravity Preset 186CC1.5" 186CC2 1.0" 186CC3 1.5" 186CC4 2.0" 186CC5 2.5" 186CC6 3.0" 186CC7 3.5" 186CC8 4.0" Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 Rigid April 2012, Rev G Page 3

4 Camber See FIGURE CI CI CI4 6 (NA w/ Mag wheel) Figure 10 Frnt t Rear Seat Height Matrix 12" Seat Depth 2.5" Max Frnt t Rear Seat Hgt. 13", 14" 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. Rear Seat Height 186RH " Only w/ 20" Rear Wheel 186RH " Only w/ 20" Rear Wheel 186RH " Only w/ 20" Rear Wheel 186RH " Only w/ 20" Rear Wheel 186RH " Only w/ 20", 22" Rear Wheel 15.5" Only w/ 20" r 22". Limited 186RH16 availability w/ 24" depending n seat squeeze. 186RH " 186RH " 186RH " 186RH " 186RH " 186RH " 186RH " 186RH " 186RH " 5. REAR SEAT HEIGHT SET UP (CONT.) 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. 186RW3 186RW8 186RW1 186RW90 186RW91 186RW92 186RW93 186RW94 186RW06 186RW10 186RW16 186RW28 186RW95 186RW96 186RW97 186RW32 186RW98 20" Mag 22" Mag 24" Mag 20" Lite Spke 22" Lite Spke 24" Lite Spke 25" Lite Spke 26" Lite Spke 22" Ultra Lightweight Spke " Ultra Lightweight Spke " Ultra Lightweight Spke " Spinergy SPOX Black Spkes 24" Spinergy SPOX Black Spkes 25" Spinergy SPOX Black Spkes 26" Spinergy SPOX Black Spkes 22" Spinergy LX Black Spkes 24" Spinergy LX Black Spkes $ $ $80.00 $ $ RW99 25" Spinergy LX Black Spkes $ RW40 26" Spinergy LX Black Spkes $ RW50 24" Muntain Rear Wheel Tire 186RT3 E2218 Full Ply Tire 186RT6 High-Pressure Clincher 186RT22 E2218 Kik Mak Black 186RT27 Knbby V-TRAK by Kenda 186RT12 Muntain Only available in 24" 186RT1 Pneumatic Wheel Ultra Mag Lite Spke Spinergy 186RT28 Tire Lightweight Schwalbe Speed Run Tire Full Ply Tire 20,22,24 20,22,24 High Pressure Clincher 22,24,25,26 22,24,25 22,24,25,26 Handrim Kik Mak Black 24 24,25 24,25 Natural Fit Handrims nly available in 22", 24", & 25" Knbby V-TRAK HR1 Aluminum Andized Pneumatic 20,22,24 20,22,24,26 22,24,26 Plastic Cated NA w/ 25" & 26" 186HR4 Pneumatic w/airless Insert 20,22,24 20,22,24,26 22,24,26 Lite Spke Wheels Schwalbe Marathn Schwalbe Speed Run 24 24,25,26 24,25 22,24,25 24,25 24,25,26 24,25 186HR22 186HR23 Natural Fit - Standard Grip Natural Fit - Super Grip $ $ " = 489 mm 24" = 540 mm 25" = " = HR30 186HR31 Natural Fit LT - Standard Grip Natural Fit LT - Super Grip $ $ HR24 Spinergy Flex Rim Only available n Spinergy LX wheels 24" & 25" $ HR7 Omit Handrim NA w/ Ultra Lightweight Wheels 186AX1 186AX13 186RT2 186RT21 E2213 Pneumatic Airless Insert Schwalbe Marathn Plus Evlutin $90.00 $80.00 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 Rigid April 2012, Rev G Page 4

5 5. ARMREST Armrest - Height Adjustable Single Pst Height Adjustable - Std 186AA11 E0973 Range 8" - 13". Adjust in 1" increments 186AA29 E0973 Single Pst Height Adjustable - Lw Range 6.5" ". Adjust in 1" increments $ $ AM23 186AM21 186AM24 186AM22 Armpad - Fr Height Adjustable Desk Length (10") Classic Desk Length (10") Cntur Full Length (14") Classic Full Length (14") Cntur 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 Extensin Handle Ext. handles nly available with high munt push r pull wheel lcks 186EH7 E0961 Extensin Handle (Pair) 186WL12 186AT37 Wheel Lck Optins D Nt Munt Anti Tips E0971 Anti Tips (Pair) Increases verall width f chair. Sme interferance my exist w/ padded SA arms at lwest settings 186SG33 K0108 Plastic Standard NA w/ Height Adjustable Arms 186SG29 K0108 Plastic Lw NA w/ Height Adjustable Arms 186SG35 K SG36 K SG12 K0108 Side Guards Aluminum NA w/height Adj. Arms, High Push r Pull Wheel Lcks Aluminum w/ Fender NA w/ Height Adj. Arms, High Push r Pull Wheel Lcks Carbn Fiber NA w/ Height Adj. Arms, High Push r Pull Wheel Lcks 6. KEY OPTIONS & ACCESSORIES $60.00 $ $ $ $ Frame Clr 186C C2 Black 186C10 Black Opal 186C38 Blue Opal 186C36 Candy Blue 186C14 Candy Purple 186C35 Candy Red 186C128 Cpper 186C6 Frest Green 186C127 Fuchsia 186C126 Glw 186C116 Matte Black 186C117 Matte Green 186C4 Midnight Purple 186C5 Pearl Pink 186C103 Rtbeer 186C114 Sparkle Silver 186C113 Titanium Clr Paint 186C11 Txic Green 186C8 Yellw 186C C43 186C42 186C108 Custm Frame Clr Desert Camuflage $ Mssy Oak Camuflage $ Stars & Stripes $ 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 Side Guard - Clr Optin can be rdered separately Available with Aluminum r Aluminum with Fender. 186EB07 Black 186GE01 Black 186EB08 Blue 186GE02 Matching Frame- Standard Clrs 186EB09 Green 186GE03 Matching Frame- Custm Clr $ EB10 Purple Psitining Belt 186EB11 186EB12 Red Ti Grey 186A117 E0978 Belt 2" Aircraft Buckle w/clamps $ A118 E0978 Belt 2" Aircraft Buckle Padded Built Fr Me $ w/clamps T inquire abut any unique custmizatin fr Quickie prducts, cntact: 186A141 E0978 Belt 1.5" Aut Buckle Universal Phne: (800) , Optin #3, Fax: (800) $70.00 w/clamps $ Spke Guards 186A23 K0065 Black Spke Guard 186A302 K0065 Quickie "Q" Clear $ $ Additinal Pack Accessries 186A1 Backpack - Adult $ A2 Backpack - Kids $ A8 Black Seat Puch $ A203 E2207 Miscellaneus Crutch Hlder Tl Kit $ $ A83 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 Rigid April 2012, Rev G Page 5

6 7. APPENDIX BASE CHAIR WEIGHTS DEPTH WIDTH **Weights are prvided as a guideline, actual can vary because f sizing, manufacturing, r material variances. Example 20" tire vs. 24". **Nt all frame set up r ptins are listed Base Chair Includes: Frnt Caster 4" Lw Prfile Ply Frk Lw Narrw Caster Blt Caster Stem Shrt (1.75") Ft Rest Aluminum Tubular Rear Wheel 24" Lite Spke Wheel Tire Pneumatic Handrim Aluminum Andized Backrest Active Rigid Backrest Backrest UPH Standard Seat Sling Standard Pushhandles Omit Push Handle Wheel Lck Erg Scissr Cmpnent lbs Cmpnent lbs Cmpnent lbs Cmpnent lbs Seat Sling DAB Rear Tires (Pair) Wheel Lck (Pair) Standard Seat Sling 0.00 With Padded S/A Armrest 1.20 Full Ply 0.70 Push Wheel Lck 0.16 Ultra Seat Sling With Out Padded S/A Armrest 0.66 High-Pressure Clincher Pull Wheel Lck 0.16 Omit Seat Sling Backrest with Twel Bar Kik Mak Black 1.12 Erg Scissr 0.00 Seat Cushin 4" Tw el Bar 0.04 Knbby V-Trak by Kenda 0.89 Cmpact Wheel Lck " Cushin 1.26 Adj Height BackRest 10-14,12-16, Muntain Tire 1.54 Grade Aid Hardw are Omit Cushin 0.00 Adj Height BackRest Pneumatic 0.00 Direct Munt Caster Wheels (Pair) 8" Fixed Height Backrest Pneumatic Airless Insert 2.00 Omit Wheel Lck " Micr " Fixed Height Backrest Schw albe Marathn Plus Evlutin 0.34 Wheel Lck Extensin Handle 4" Lw Prfile Ply " Fixed Height Backrest Schw albe Speed Run " Pair " Micr Lighted " Fixed Height Backrest Handrims (Pair) Rear Anti-tip 4" x 1" AluminumPly " Fixed Height Backrest AluminumAndized 0.00 Anti-tip 24" Wheel " x 1.25" Semi Pneu " Fixed Height Backrest Aluminum - Ultra Wheel Only Omit Anti-Tips x 1.5" AluminumSft Rll " Fixed Height Backrest Plastic Cated 1.60 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 " Sft Rll Semi Pneu " Fixed Height Backrest 0.06 Natural Fit LT Standard Grip 1.57 Carbn " x 1" AluminumPly " Fixed Height Backrest 0.08 Natrual Fit LT Super Grip 1.57 AluminumSide Guard " x 1.5" Semi Pneu " Fixed Height Backrest 0.11 Armrests (Pair) AluminumSide Guard w ith Fender " x 1.5" AluminumSft rll 1.04 Active Rigid Backrest 0.23 Padded S/A Assembly 2.97 Accessries 6" Ply 0.67 Backrest UPH SPHA Standard 4.33 Backpack " x 1.5" Semi Pneu 0.88 Tensin Ballistic 0.51 SPHA Lw 3.76 Backpack Kids "x 1.5" AluminumSft Rll 1.35 Tensin Vented 0.47 Armrest Pads (Pair) Black Seat Puch " Pneumatic 0.55 Standard 0.00 Desk Length - Classic 2.22 Belt 2" Aircraft Buckle 0.44 Caster Frks (Pair) Omit Uphlstery Desk Length - Cntur 1.14 Belt 2" Aircraft Buckle Padded 0.60 Lw Narrw 0.00 Push Handles (Pair) Full Length - Classic 2.73 Belt 1.5" Aut Buckle Universal 0.38 Lw Wide 0.07 Integral Push Handles Shrt 0.10 Full Length - Cntur 1.50 Crutch Hlder 0.57 Lw Single Sided 0.02 Integral Push Handles Medium 0.17 Rear Wheel (Pair) Gel Cver Armrest Pad 0.48 Standard Narrw 0.04 Integral Push Handles Tall " Mag Wheel 0.82 Neprene Impact Guards 0.11 Standard Wide 0.12 Fld-Dw n Push Handles 12-16, " Mag Wheel 1.32 Wheelchair Tray 6.50 Standard Single Sided 0.09 Fld-Dw n Push Handles " Mag Wheel 1.78 Axles (Pair) Frg Legs 0.62 Omit Push Handle " Lite Spke Wheel Quick Release (Light Spke Wheel) 0.00 Ftrest Omit Push Handle " Lite Spke Wheel Quick Release (Spinergy, Ultra-Light) 0.03 AluminumTubular 0.00 Omit Push Handle " Lite Spke Wheel 0.00 Quick Release (Mag Wheels) 0.00 AluminumTubular Lng 0.06 Omit Push Handle " Lite Spke Wheel 0.07 Quad Quick Release 0.13 AluminumPlatfrm 1.07 N Push Handles " Lite Spke Wheel 0.27 Suspensin AluminumPlatfrmLng 1.14 Leg Strap 20" Ultra Lightw eight Spke Wheel Link Suspensin Assembly 2.75 Ultra Lite Aluminum Ftrest 0.36 N Leg Strap " Ultra Lightw eight Spke Wheel Ultra Lite Aluminum Ftrest Lng 0.41 Leg Strap (10-14") " Ultra Lightw eight Spke Wheel Ftrest Optins Leg Strap (15-17") " Ultra Lightw eight Spke Wheel Remvable Snap On Cver (16" Wide) 0.24 Leg Strap (18-20") " Spinergy SPOX Black Wear Pads (ea) Need 2 per chair 0.02 Back Type 25" Spinergy SPOX Black 0.15 Adaptive Platfrm2" Spacer 0.16 Angle Adj. Flding Lck Dw n Back " Spinergy SPOX Black 0.43 Adaptive Platfrm4" Spacer 0.34 Nn-Flding Backrest " Spinergy LX Black Adaptive Platfrm6" Spacer " Muntain (Uses a 22" Rim) 2.97 Psitin Plate fr AluminumFtrest 1.04 N Ft Rest Optins 0.00 Custmer Service: Fax: rders@sunmed.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US) LLC. (12.11) Q7 Rigid April 2012, Rev G Page 6