Orderform Balder Finesse Tilt

Transcription

1 Orderfrm Balder Finesse Tilt 74383F_ENG Cmpany: Cuntry: Order number: Date f rder: Way f transprtatin: Shipping agent:

2 Custmer Fact Find Custmer infrmatin Custmer name: Assessment date: Assessment lcatin: Attendees: Dealer infrmatin Name: Cntact inf: Address: Phne, fax: Page 2/16 Custmer facts Visin: Weight: Hearing: Stability: Medical histry: Intended use: Indrs Outdrs Bth Lcatins: Hme Wrk/Schl Bth Vehicle use: Passenger Driver Bth Vehicle (make and mdel): Tested in vehicle: Pass Fail Current chair details (phtgraph t be taken): Measurements Custmer name: A B D A B C D E C E Hip width: Ntes: Signature: Date:

3 Balder Finesse Tilt Page 3/16 Basic Chair Base Unit Chassis Balder with seat lift actuatr HP * Seat Lift ex. seat lift actuatr HP * Seat frame HP * Rear carriage HP * Back frame assembly HP * Electrnics Tilt functin HP * Items abve are frced ptins when rdering a Finesse Wheel Optins Wheels Puncture-prf, 1 pcs cmplete HP (x2) cmplete HP4626 (x2) Air, 1 pcs cmplete HP (x2) cmplete HP4627 (x2) Seat Unit Optins Seat unit Tilt functin Electrical 15 til +45 Manual 15 til +45 Back functin Electrical Manual HP HP HP HP Cver Optins Plastic cver fr chassi and back-frame Cver Cver chassi dzus seat stabilizer HP Cver chassi dzus Cver back frame HP * HP * Clur cver Grafit grey* Red Blue Green Unique adjusted clur (RAL n) Batteries and Charger Optins Batteries A500 Cyclic 12V GF Y HP9425 (x2)* Charger Medic CCC932 24V/10A HP9620* Jystick Optins Jystick * = Standard ptins DX-REMG90A DX-REMG90T with tggle switches Dlphin Remte DX- REM34 Jystick attachment Standard DX-G80/DX-G90 Swing-away Magnet lck Unique adjustment (specify n page 16) DX-REM34 DX-G80/DX-G90 DX-REM34 Munted right* Munted left HP10924* HP10925 HP1178 HP HP HP * HP

4 Attendant Cntrls Attendant cntrls Cntrl unit ACU3, attendent cntrl with ARC5 ACU1, attendent cntrl Separate panel with seatfunctins, ARC5 Attendent cntrl with wrist supprt with emergency stp switch Balder 2 Unique adjustment (specify n page 16) Special Steerings HP HP HP HP HP HP Page 4/16 Special steering Cntrl unit Sip and puff Chin cntrl HP HP Base unit 3-switch-driving head cntrl HP Unique adjustment (specify n page 16) Cmfrt Back Cmfrt back Cmfrt 1 Cmfrt 2 Hight (Q+P) = 440 (73¼), width (R) = 400 (15¾), S = 270 (10¾) Hight (Q+P) = 460 (7¼), width (R) = 400 (15¾), S = 270 (10¾) Up Cmfrt 3 Hight (Q+P) = 490 (19¼), width (R) = 420 (16½), S = 290 (11½) Cmfrt 4 Hight (Q+P) = 540 (21¼), width (R) = 440 (17¼), S = 310 (12¼) Cmfrt 5 Hight (Q+P) = 580 (22¾), width (R) = 460 (18), S = 330 (13) Cmfrt 6 Hight (Q+P) = 620 (24½), width (R) = 480 (19), S = 350 (13¾) Dwn All measures in mm (inch) Chse chassi and add pad t cmbine a cmplete backrest. Cmfrt Back Back Anti shear functin HP * Back chassis Cmfrt 1 HP Cmfrt 2 HP Cmfrt 3 HP Cmfrt 4 HP * Cmfrt 5 HP Cmfrt 6 HP Back pad standard Cmfrt 1 HP T = 50 mm (2 ), Cmfrt 1-6 Cmfrt 2 HP Cmfrt 3 HP Bttm Cmfrt 4 Cmfrt 5 HP * HP Cmfrt 6 HP Back pad with big side members Cmfrt 1 HP U = 110 mm (4¼ ), Cmfrt 1-6 Cmfrt 2 HP Cmfrt 3 HP Bttm Cmfrt 4 Cmfrt 5 HP HP Cmfrt 6 HP Back pad with air lumbar supprt Cmfrt 1 HP Cmfrt 2 HP Cmfrt 3 HP Cmfrt 4 HP Cmfrt 5 HP Cmfrt 6 HP Back pad with air lumbar big side members Cmfrt 1 Cmfrt 2 HP HP Cmfrt 3 HP Cmfrt 4 HP Cmfrt 5 HP Cmfrt 6 HP * = Standard ptins

5 Material Clur Unique adjustment (sketches and specificatins n page 12) Standard* Skye Leather Other: Specify n page 12 Standard* Other: Specify n page 12 Page 5/16 Cmfrt Seat Cmfrt seat Rear Cmfrt 1 Seat depth (W) = 425 (16¾), effective: 400 (15¾), Width (X) = 400 (15¾) Cmfrt 2 Seat depth (W) = 450 (17¾), effective: 425 (16¾), Width (X) = 400 (15¾) Cmfrt 3 Seat depth (W) = 475 (18¾), effective: 450 (17¾), Width (X) = 420 (16½) Cmfrt 4 Seat depth (W) = 500 (19¾), effective: 475 (18¾), Width (X) = 440 (17¼) Cmfrt 5 Cmfrt 6 Seat depth (W) = 525 (20¾), effective: 500 (19¾), Width (X) = 460 (18) Seat depth (W) = 540 (21¼), effective: 525 (20¾), Width (X) = 480 (19) All measures in mm (inch) Frnt Chse chassi and ad pad t cmbine a cmplete seat unit. Cmfrt seat Seat chassis Cmfrt 1 Cmfrt 2 Cmfrt 3 Cmfrt 4 Cmfrt 5 Cmfrt 6 HP HP HP HP * HP HP Hard plate adj W:38 42 cm (15 16½ ) D:38 45 cm (15 17¾ ) W:42 45 cm (16½ 17¾ ) D:45 52 cm (17¾ 20½ ) HP HP Nte: Hard plate seat is cmpletely flat and suitable fr usage f special cushins. Frnt Frnt Seat pad standard Z = 20 mm (¾ ), Cmfrt 1-6 Seat pad with big side members Y = 70 mm (2¾ ), Cmfrt 1-6 Cmfrt 1 Cmfrt 2 Cmfrt 3 Cmfrt 4 Cmfrt 5 Cmfrt 6 Cmfrt 1 Cmfrt 2 Cmfrt 3 Cmfrt 4 Cmfrt 5 Cmfrt 6 HP HP HP HP * HP HP HP HP HP HP HP HP Preassure relief seat pad Cmfrt 1 Cmfrt 2 Cmfrt 3 Cmfrt 4 Cmfrt 5 Cmfrt 6 HP HP HP HP HP HP Preassure relief seat pad with big side members Cmfrt 1 Cmfrt 2 Cmfrt 3 Cmfrt 4 Cmfrt 5 Cmfrt 6 HP HP HP HP HP HP Material Standard* Skye Leather Other: Specify n page 14 Clur Standard* Other: Specify n page 14 Unique adjustment (sketches and specificatins n page 14) * = Standard ptins

6 Incntinence cver Standard Cmfrt 1 Cmfrt 2 Cmfrt 3 Cmfrt 4 Cmfrt 5 Cmfrt 6 with big side members Cmfrt 1 Cmfrt 2 Cmfrt 3 Cmfrt 4 Cmfrt 5 Cmfrt 6 HP HP HP HP HP HP HP HP HP HP HP HP Page 6/16 Headrest Chse fastner (A) + pad (B) t cmbine a cmplete headrest. Headrest Headrest fastner HP Headrest pad Big HP A Small HP B Material Clur Unique adjustment (sketches and specificatins n page 10) Standard Skye Leather Other: Specify n page 10 Standard Red Blue Other: Specify n page 10 Armrest Armrest Cmfrt 1-2 Cmfrt 3-4 Cmfrt 5-6 Length: 300 mm (11¾ ) Length: 375 mm (14¾ ) Length: 450 mm (17¾ ) B A Chse fastner (A) + pad (B) t cmbine a cmplete armrest. Armrest fastener Flip up, set Cmfrt 1-2 Cmfrt 3-4 Cmfrt 5-6 Flip up, height adjustable, set Cmfrt 1-2 Cmfrt 3-4 Cmfrt 5-6 Armrest pad right side Cmfrt 1-2 Cmfrt 3-4 Cmfrt 5-6 left side Cmfrt 1-2 Cmfrt 3-4 Cmfrt 5-6 Unique adjustment (sketches and specificatins n page 16) HP HP * HP HP HP HP HP10085 HP1079* HP10086 HP10085 HP1079* HP10086 * = Standard ptins

7 Ftrest Page 7/16 Chse legrest base unit (A), ftplate (B) and calf pad (C) t cmbine a cmplete ftrest. Legrest Base unit Manual HP C B A Legrest manual Cmfrt 1-3, right Cmfrt 1-3, left Cmfrt 4-6, right Cmfrt 4-6, left HP HP HP HP Legrest manual Single 35-37,5 (13¾-14¾ ), Cmfrt 1-3 Single (15¾-19¾ ), Cmfrt 4-6 HP HP Base unit with aut. lenght cmp. HP Base unit with el. lenght cmp. 100 mm (4 ) 150 mm (6 ) 200 mm (7¾ ) HP HP * HP Ftplate Divided Large, D22 cm (8¾ ), right Large, D22 cm (8¾ ), left Small, D16 cm (6¼ ), right Small, D16 cm (6¼ ), left HP * HP * HP HP Single HP Calf pad Large, W12 cm (4¾ ), H22 cm (8¾ ) Small, W12 cm (4¾ ), H16 cm (6¼ ) HP (x2)* HP (x2) Te strap 1 pcs HP Wheels Fr el. legrest HP Unique adjustment (sketches and specificatins n page 16) Clamp Dwn Units Clamp dwn units Wheelchair unit fr EZ-Lck Transprtatin lck system HP Wheelchair unit incl panel Unit munted n the Balder HP Spigt unit Unit munted in the car HP Undercarriage fr car seat Fr usage n riginal car seat HP Seat stabilizer unit HP * = Standard ptins

8 Accessries Page 8/16 Light Lights Frnt and rear HP Lights with indicatrs Frnt and rear HP Lights with ACU3 Jystick Frnt and rear HP Supprt pads Supprt pad seat back, set 8x10 cm (3¼x4 ), Cmfrt x15 cm (4x6 ), Cmfrt 4-6 HP HP Knee/thigh pad, set 10x15 cm (4x6 ), Cmfrt 1-6 HP Abductin pad Remvable, height adjustable Remvable, with velcr HP HP Tray Swing-aside Cmfrt 1-2, right Cmfrt 1-2, left Cmfrt 3-4, right Cmfrt 3-4, left Cmfrt 5-6, right Cmfrt 5-6, left HP HP HP HP HP HP Swing-aside, small right left HP HP Crutch fitting Under armrest 1 crutch 2 crutches HP HP Crutch fitting with strap 2 crutches HP Munted right Munted left Belts Hip safety belt with reel with autlck HP HP Chest harness HP Shulder strap fr 4-pint harness HP Basket and bags Fixing bar fr backpack/bag HP Basket, remvable fitted t back HP Armrest bag with velcr with zipper HP HP Munted right Munted left Backpack, 40x40x8 cm (15¾x15¾x3¼ ) HP Balder backpack, black HP Varius accessries Main circuit switch HP Emergency stp switch HP Wheelhair cver HP Mirrr fldable munted n armrest HP HP Hurcunter HP Platfrm fr breathing device W30 cm (11¾ ) D25 cm (9¾ ) HP Anti Crush Guard HP Emblem, reflective, set HP10957

9 Sketches and measurements Adjustments and unique adjustments Page 9/16

10 Unique adjustments Headrest Page 10/16 Small pad Big pad Psitin Small Big Measurements A 60 (2¼ ) 60 (2¼ ) B 260 (10¼ ) 260 (10¼ ) C 180 (7 ) 230 (9 ) D 90 (3½ ) 110 (4¼ ) E 60 (2¼ ) 75 (3 ) Ntes fr unique adjustments:

11 Unique adjustments Cmfrt back pad Page 11/16 Up Dwn Dwn Dwn Back pad Cmf 1 Cmf 2 Cmf 3 Cmf 4 Cmf 5 Cmf 6 Measurements P 280 (11 ) 290 (11½ ) 305 (12 ) 330 (13 ) 350 (13¾ ) 370 (14½ ) Q 160 (6¼ ) 170 (6¾ ) 185 (7¼ ) 210 (8¼ ) 230 (9 ) 250 (9¾ ) R 400 (15¾ ) 400 (15¾ ) 420 (16½ ) 440 (17¼ ) 460 (18 ) 480 (19 ) S 270 (10¾ ) 270 (10¾ ) 290 (11½ ) 310 (12¼ ) 330 (13 ) 350 (13¾ ) T 50 (2 ) 50 (2 ) 50 (2 ) 50 (2 ) 50 (2 ) 50 (2 ) U 110 (4¼ ) 110 (4¼ ) 110 (4¼ ) 110 (4¼ ) 110 (4¼ ) 110 (4¼ ) Inf measurements Ttal height (P+Q) 440 (17¼ ) 460 (18 ) 490 (19¼ ) 540 (21¼ ) 580 (22¾ ) 620 (24½ )

12 Seat unit - Back Page 12/16 P: Height frm the upper edge f side members t the tp edge f seat back. A change f the P-measurement will change the height f the tp f the seat back. Reducing P will reduce the height at the tp f the seat back. Increasing P will increase the height at the tp f the seat back. If the measurement is changed, the verall height f the seat back will be accrdingly changed. Nte: Increase the P-measurement if yu want an increased ttal seat back height withut increasing the height f the side members. Q: Height frm the upper edge f the side members t the lwest part f seat back. A change f the Q-measurement will change the height f the lwest part f the seat back. Reducing Q will reduce height f the lwest part f the seat back and reducing the height f the side members. Increasing Q will increase the height f the lwest part f the seat back and increasing the height f the side members. If the Q-measurement is changed, the verall height f the seat back will be accrdingly changed. Nte: Increase the Q-measurement if yu want increased height f the side members and ttal height f seat back. If nly an increased height f the side member is desired, withut changing the verall seat height; increase the Q-measurement and reduce the P-measurement accrdingly. R: Ttal width f seat back (measured at the widest part; side members). A change f the R-measurement will change the verall width f the seat back, frm the bttm t the tp. The width f the centre sectin f the seat back will be changed accrdingly. Reducing R will reduce the verall width f the seat back and the width f the centre sectin. Increasing R will increase the verall width f the seat back and the width f the centre sectin. If the R-measurement is changed, the width between the armrests will be changed accrdingly. Nte: Change the R-measurement when yu want t change the width f the seat back and the width f the centre sectin frm the bttm t the tp f the seat back. Changing the width at the tp and at the bttm f the seat back with different dimensin; make a dimensinal sketch with specified R and the S-measurement. S: Width f the seat back at the tp f the seat back. A change f the S-measurement will change the width at the tp f the seat back. Increasing S will increase the width at the tp f the seat back and accrdingly at the tp f the centre sectin. Reducing S will reduce the width at the tp f the seat back and accrdingly at the tp f the centre sectin. A change f the S- measurement will nt change the verall width f the seat back. Changing the R-measurement changes the verall width f the seat back. Nte: Change the S-measurement when yu want t change the width at the tp f the seat back. T: Depth f the standard side members. A change f the T-measurement will change the depth frm the tip f the side member t the centre sectin f the seat back. Increasing T will make the side members bigger and the seat back will feel a little tighter. Reducing T will make the side members smaller and the seat back will be mre flat with less supprt. U: Depth f the big side members. A fixed change f the depth frm the tip f the side member t the centre sectin f the seat back. When big side members are chsen, the depth will increase with 60mm t a ttal f 110mm.The big side members will feel firmer than the standard side members, and the seat back will feel tighter. Ntes fr unique adjustments:

13 Unique adjustments Cmfrt seat pad Page 13/16 Rear Frnt Frnt Frnt Psitin Cmf 1 Cmf 2 Cmf 3 Cmf 4 Cmf 5 Cmf 6 Measurements Effective seat depth 400 (15¾ ) 425 (16¾ ) 450 (17¾ ) 475 (18¾ ) 500 (19¾ ) 525 (20¾ ) W 425 (16¾ ) 450 (17¾ ) 475 (18¾ ) 500 (19¾ ) 525 (20¾ ) 540 (21¼ ) X 400 (15¾ ) 400 (15¾ ) 420 (16½ ) 440 (17¼ ) 460 (18 ) 480 (19 ) Z 20 (¾ ) 20 (¾ ) 20 (¾ ) 20 (¾ ) 20 (¾ ) 20 (¾ ) Y 70 (2¾ ) 70 (2¾ ) 70 (2¾ ) 70 (2¾ ) 70 (2¾ ) 70 (2¾ )

14 Seat unit - Seat Page 14/16 W: Ttal length f seat pad NOTE! Effective seat depth is 25mm shrter than the ttal length f the seat pad, see chart. A change f the W-measurement will change the verall seat pad length and the effective seat depth. Fixed lengths f seat pads are mm. A change f the W-measurement will change the verall seat pad length and the length f the side members will be changed accrdingly. Nte: Yu want an effective seat depth f 500mm. Check the chart. The seat pad with a ttal length f 525mm will give yu an effective seat depth f 500mm. Effective seat depth can be increased with 25 r 50mm by mving the cmplete seat back ne r tw hles backwards, withut changing the verall length f the seat pad. If the seat back is mved mre than 50mm, the verall length f the seat pad must be changed als. NOTE! If the seat back is mved, the bar frm the seat back t the tiltswitch must be changed als. X: Width f seat pad, uter edge A change f the X-measurement will change the verall width f the seat pad frm the rear t the frnt. The width f the centre sectin f the seat pad will be changed accrdingly. Reducing X will reduce the verall width f the seat pad and the width f the centre sectin. Increasing X will increase the verall width f the seat pad and the width f the centre sectin. Nte: Increase the X-measurement when yu want a wider seat. Y: Height f standard side members A change f the Y-measurement will change the height frm the tp f the side member t the centre sectin f the seat pad. Increasing Y will make the side members bigger and the seat pad will feel a little tighter. Reducing Y will make the side members smaller and the seat pad will be mre flat with less supprt. Z: Height f the big side members A fixed change f the height frm the tp f the side member t the centre sectin f the seat pad. When big side members are chsen, the height will increase with 50mm t a ttal f 70mm. The big side members will feel firmer than the standard side members, and the seat pad will feel tighter. Ntes fr unique adjustments:

15 Unique adjustments Page 15/16 Armrests flip-up unit Psitin Cmf 1 2 Cmf 3 4 Cmf 5 6 Measurements A 300 (11¾ ) 375 (14¾ ) 450 (17¾ ) B 75 (3 ) 75 (3 ) 75 (3 ) C 400 (15¾ ) 440 (17¼ ) 480 (19 ) D Rubber Rubber Rubber Armrest placing Frm seat frame 1 frm seat 265 (10½ ) (7½ 11½ ) 2 frm seat 290 (11½ ) (8½ 12½ ) 3 frm seat 315 (12½ ) (9½ 13½ ) 4 frm seat 340 (13½ ) (10½ 14¼ ) Nte: Armrest are placed in hle 3 n cmfrt 3 6 and hle 2 n cmfrt 1 2 as standard. Tilt: Armrests fllw the seat 5 frm seat 365 (14¼ ) (11½ 15¼ ) std height adj. Unique adjustments Ft rest Psitin Std measure Measurement A (11¾ 17¾) B 220 (8¾ ) C 150 (6 ) D 225 (8¾ ) E 135 (5¼ ) F 35 (1½ ) Nte: A: Measures in 90º Can be 50mm (2 ) shrter by remving calf pads. Measure A, ft rest with el. length cmp. 100mm 150mm 200mm A: (13 20½ ) A: (13 22½ ) A: (13 24½ ) G H I 340 (13½ ) 220 (8¾ ) 260 (10¼ )

16 Ntes fr unique adjustments: Page 16/16