Quickie QM-715 HD Group 3

Transcription

1 Quickie QM715 HD Group 3 (K0848, K0856, K0861) EIPW11, November 2013 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions. The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy. Option # HCPCS Definition Price Option # HCPCS Definition Price 1. QUICKIE QM715 HD GROUP 3 CATEGORY (Select One) QUICKIE QM715 HD BC (Group 3 K0850/K0011) QUICKIE QM715 MPC (Group 3 K0862/K0011) Quickie QM715 HD BC w/ ASAP II Seat (Fig 1.1) $6, Quickie QM715 HD MPC SPOT Tilt/Recline (Fig. 1.3) $6, PC79 K0850 Base Package 172PC104 K0862 Base Package $6, K0011 VR2 90A Drive Control (nonexpandable) K0011 VR2 90A Drive Control (nonexpandable) 400 lb 5 mph 4pole Motor Package 350 lb 5 mph 4pole Motor Package ASAP II Rehab Seat Frame 14" Drive Wheels (flat free insert ) Recline Seat Frame 14" Drive Wheels (flat free insert ) 8A Dual Mode (Compact) CTE 8A Dual Mode (Compact) CTE 172NB88 K0850 QM715 HD BC BASE ONLY For use with Aftermarket Seat frame. $6, NB102 K0862 QM715 HD MPC BASE ONLY For use with Aftermarket Seat frame. $6, EQ19 QM715 HD BC SEAT ONLY w/o elect. For use to add/replace seating when additional electronics are not required. $ EQ36 QM715 HD MPC SEAT ONLY w/ elect. For use to add/replace seating when additional electronics are required. $ EQ18 QM715 HD BC SEAT ONLY w/ elect. For use to add/replace seating when additional electronics are required. $ QUICKIE QM715 HD SC (Group 3 K0858/K0011) Quickie QM715 HD SC for SPOT Tilt (Fig 1.2) $6, PC80 K0858 K0011 Base Package VR2 90A Drive Control (nonexpandable) 400 lb 5 mph 4pole Motor Package ASAP II Rehab Seat Frame 14" Drive Wheels (flat free insert ) 8A Dual Mode (Compact) CTE 172NB89 K EQ21 QM715 HD SC BASE ONLY For use with Aftermarket Seat frame. QM715 HD SC SEAT ONLY w/o elect For use to add/replace seating when additional electronics are not required. $6, $ EQ20 QM715 HD SC SEAT ONLY w/ elect. For use to add/replace seating when additional electronics are required. $ QM715 HD BC 1.2 QM715 HD SC 1.3 QM715 HD MPC Page 1

2 2. BASE CHAIR OPTIONS Speed Package 172PF84 400lbs / 5 mph 4 Pole Motor Shroud Color 172EZ01 Candy Apple Red 172EZ02 High Gloss Black 172EZ03 Candy Blue 172EZ04 Silver 172EZ05 Copper 172EZ08 Green Apple 172EZ09 172EZ10 Pearl Pink 172WL42 Wheel locks $ EZ12 Yellow 172EZ11 Candy Purple Matte Black 172EZ13 Midnight Blue 172VT4 E1029 Fixed Vent Tray (Pulmonetic LTV Models) $ EZ15 Pearl White 172EZ06 Digital Camo. $ EZ07 Woodland Camo. $ FA EZ14 Carbon Fiber Print $ Drive Wheel 172DW36 172DW37 172DW59 Wheel locks Ventilator Options 14" Cast Wheel Pneumatics Grey Knobby Tires and Grey Casters 14" Cast Wheel Solid Dual Density Inserts Grey Knobby Tires and Grey Casters 14" Cast Wheel Solid Dual Density Inserts Black Knobby Tires and Black Casters PreSet Seat Frame Angle (STFH increases 1" per increment change) 172FA3 3 Not available with Tilt 172FA4 6 Seat Height (Use STFH Matrix below) (Measured in the front) Obtain Quote to verify est. STFH User weight 172HT44 Lowest STFH 172WG lb 172HT49 +.5" STFH Requires Group 34 Batteries 172WG lb 172HT45 +1" STFH 172WG lb (NA with Power Recline) 172HT46 172HT47 172HT48 +2" STFH +3" STFH +4" STFH Seating Type and Power Option Combinations STFH Matrix BC ASAP II No power seating.* SC Power Recline Only Seat * 16.1 SeattoFloor Height at 0 tilt Low +.5" +1" +2" +3" +4" SC ASAP II HD Tilt only MPC HD Tilt and Power Recline seating *Adding seat angle will increase STFH by 1" for each incremental change. STFH measured with batteries but no user. Actual STFH may vary by.5" 3. BATTERIES and CHARGERS Batteries (Gel Cells) Battery Charger 172AG04 E2363 Group 24 Flat Top Gel Cell (Pair) w/straps Recommended for Maximum Daily Range $ BJ19 8A Dual Mode (Compact) CTE 172BJ3 Omit Charger $ AG11 E2359 Group 34 Flat Top Gel Cell (Pair) w/straps, Required for lower STFH. $ AG13 Omit batteries Ready for Group 24 or 34 Includes harness and straps. Page 2

3 4. ELECTRONICS Drive Control Options 172ER01 Nonexpandable controller Switch Mount Bracket 172EM01 Single Switch Mount Bracket $ RNet Expandable Drive Control Upgrade (90A) $ EM02 Dual toggle switch mount bracket $ EX01 E2377 Expandable Controller Rnet $ EM03 4way toggle switch mount bracket. $ EX02 E2313 Harnessing for Expandable Controller $ VR2 Joystick (nonexpandable) 172J94 Non Expandable VR2 Joystick Specialty Driver Control Options Rnet Joystick (for expandable electronics) Requires expandable controls and OMNI. Not available with Upholstered backs. 172J70 Std LED Joystick for Expandable Ctrls 172J108 Joystick w/stereo Jacks & Color Display $ Quickie Sip n' Puff System $2, ID34 E2325 Sip N' Puff Kit $1, J88 Joystick W/Toggle, Spd Pot, Stereo Jacks & 172II01 E0955 Headrest $ Color Display 172IJ01 Headrest Removable Mount 172J95 Omit JS for use with OMNI 172IH1 E2326 Sip n' Puff Tubing and Hardware $ ASL Head Array Package (Adult) $4, Joystick Mount (Fixed or Swing Away) 172II02 E2330 ASL Proximity Head Array (Adult) $3, JM10 Fixed Mount 172IJ01 Headrest Removable Mount 172JM11 Swing Away Mount $ ASL Head Array Package (Ped) $4, Joystick Mount (Location) 172II03 172IJ01 E2330 ASL Proximity Head Array (Ped) Headrest Removable Mount $3, Height Adjustable. SwitchIt Head Array Package (Adult) $4, HM1 Right Side Mount 172II04 E2330 Switchit Proximity Head Array $3, HM2 Left Side Mount 172IJ01 Headrest Removable Mount SwitchIt Head Array Package (Pediatric) $4, Joystick Handle (Optional) 172II05 E2330 Switchit Proximity Head Array $3, JH1 E2323 Ball Handle $ IJ01 Headrest Removable Mount 172JH2 E2323 Foam Ball Handle $75.00 ASL Proportional Mini Joystick 172JH4 E2323 THandle $75.00 Chin / Lip Control Package $4, JH6 E2323 Goalpost $ ID36 172II01 E2312 E0955 Mini Joystick Headrest $4, Rnet OMNI and Output Options 172IJ01 Headrest Removable Mount (For expandable controls, choose all that apply) ASL Proportional Mini Joystick Rnet OMNI Input Control Module and display with Midline with Gatlin Package $4, ON1 built in Infrared and armrest mount. Choose mount below. (required for Specialty Input Devices.) $ ID37 172IJ03 E2312 Mini joystick S/A Joystick Mount $4, ON2 E2351 Rnet Output Module (ECM) $ Quickie Proportional Chin Control Package $4, ON3 Rnet Bluetooth Mousemover $ ID45 172IJ03 E2312 Proportional Joystick S/A Joystick Mount $4, OMNI Mount (If used with Joystick must be mounted opposite side) Attendant Control 172DS03 Swing Away Left Side OMNI Mount 172DS04 Swing Away Right Side OMNI Mount $ $ A01 E2331 Attendant Control for VR2 $ A02 E2331 Attendant Control for Rnet $ Switch inputs for Joysticks or OMNI Attendant Mounting location Drive or Mode / Profile Control 172DN1 Mounting location: Right Back Cane 172SW22 Stereo to 2 Mono Splitter $ DN2 Mounting Location: Left Back Cane 172SW6 Ribbon Switch $ SW1 Buddy Button Switch $75.00 Electronic Programmers 172SW2 Disc Switch $ PR2 VR2 Hand Held Programmer $ SW9 Wobble Switch $ PR5 Rnet PC Programmer with Dongle $ SW4 Micro Light Switch $ PR6 DTT VR2 and Rnet cables included. $1, SW24 Egg SwitchBlack $ SW21 Dual toggle switch only 172SW23 4way toggle switch w/5th button DB9 Connector. Page 3

4 5. SEAT TYPE 172ST56 ASAP II Frame size Quickie A.S.A.P II (Adjustable Seating and Positioning) Choose Seat Frame Size Platform. (each frame is width and depth adjustable within given range. ) OR 172ST57 Recline Seat Frame size 172FU27 Power Recline (requires Expandable Rnet electronics) Power Recline Seat Frame ( H ) 18x18 to 22"x22" (Not width Adjustable) 172FU18 Adjustable 16x12 to 20x20 ( B ) Adjustable 18x16 to 22x22 ( C ) 172FU19 Note: Choose this seat when selecting the Fixed 24" wide B4me option ( D ) 6. SEAT SIZE Seat Size Matrix. Seat type is chosen in section 5. B = ASAP II Seat Frame (Adjustable from 16X16 to 20X20) C = ASAP II Seat Frame (Adjustable from 18X16 to 22X22) D = Fixed Seat Frame 24" (Depth Adjustable 16 to 22) Depth ASAP II Seat Width 16" 17" 18" 19" 20" 22" 24" 16" B B B,C B,C B,C C D Recline Seat Width 17" B B B,C B,C B,C C D 18" 20" 22" 18" B B B,C B,C B,C C D 18" H H H 19" B B B,C B,C B,C C D 19" H H H 20" B B B,C B,C B,C C D 20" H H H 21" C C C C D 21" H H H 22" C C C C D 22" H H H Seat Depth (Adjustable) H = HD Recline Seat (Width not adjustable) Note: Power Recline Seat Depth measured from solid surface of back to front of seat pan. Please accommodate for backrest cushion thickness. 172R5 16" Seat width () 172RF5 16" 172R6 17" Seat width () 172RF6 17" 172R7 18" Seat width () 172RF7 18" 172R8 19" Seat width () 172RF8 19" 172R9 20" Seat width () 172RF24 20" 172R25 22" Seat width () 172RF26 21" 172RF25 22" Seat Width Built4Me Seat Width 172VU16 E " Seat width (fixed width, depth is adjustable 16" to 22" deep) N/A with Power or manual recline back or sling back upholstery. $ Seat Depth () () () () () () () Standard Cushion 172CU1 2" Cushion 7. SEAT CUSHIONS JAY Cushions (Optional) To order any JAY cushions onchair, please see the JAY price list. $95.00 Cushion name or part number must be filled out w/ desired width and depth JAY Bundled Cushion 172JC20 Cushion Name or Part # Price List Width: Depth: 8. POWERED SEATING Power Seating Options (SC and MPC Models) 172PJ2 172PA16 172PA17 E1002 E1005 E1008 Quickie HD SPOT 50 CG Tilt (400lbs weight limit) HD Recline w/power Shear Reduction Only (350lbs weight limit) HD Tilt & Recline w/power Shear Reduction (350 weight limit) $4, $6, $10, Powered Seating Thrudrive Control Method. "Assignable Button" feature listed below (available on Rnet Systems) allows for direct "shortcut" access to various seating functions via joystick buttons. Functions accessed by depressing the button for more than 1 second. By selecting the thrudrive w/assignable button the chair will be preprogrammed with seating functions assigned to buttons on the joystick. Assignments can be changed via PC Dongle. Powered Seating Control Method (For use with power seating actuators. Switch activation is standalone and does not require expandable or thrudrive electronics. 172EO15 E2310 ThruDrive 1 Actuator options. Thru Drive 1 Actuator w/out assignable buttons. For use with VR2 or Rnet (For operating Tilt thru Joystick.) $1, EO10 172EO11 Switch Control 1 actuator w/dual toggle and mount. (For operating Tilt) Switch Control 1 actuator w/buddy button & mount. (For operating Tilt) 172EO13 E2310 Thru Drive 1 Actuator with assignable buttons. (For operating Tilt thru Joystick and/or buttons on the remote. Requires Rnet.) $1, EO12 Switch Mount (for use with switch control powered seating) 172EY01 Switch Mount Right 172EY02 Switch Mount Left Switch Control 2 3 Actuator w/ 4way Toggle Switch & Mount. (Capable of operating combo of Tilt/Legs or legs only) 172EO16 E EO14 E2311 ThruDrive 2+ Actuator options. Thru Drive 2+ Actuators w/out assignable buttons (For operating Tilt, Recline or Power Legs thru Joystick requires expandable Rnet) Thru Drive 2+ Actuators with assignable buttons. (For operating Tilt, Recline or Power Legs thru Joystick and/or buttons on the remote. Requires expandable Rnet) $2, $2, Page 4

5 172BT8 Angle Adjustable (ASAP II Seat only) 172BU1 Upholstery (Not avail with tilt or recline) Manual Recline 40 (ASAP II Seat only) not width 172BT98 E1225 $ Tension adj Upholstery Ballistic Nylon. (with 1" adjustable 172BU70 E2611 $ width adjustment.) (Not avail with tilt or recline) Manual Recline Adjustment Method Option Tension adj Upholstery 3DX Vented. 172BU71 E2611 (with 1" width adjustment) (Not avail with tilt or $ Back Cane Height 23". recline) 172MN01 Tool 172BU76 S.P.O.T. Curved 172MN02 Knob (NA with Cantilever or dual post arms.) Jay SPO Posterior Positioning 172BU77 E2613 $ Angle Adjustable Backrest Options (ASAP II only) (NA with Manual recline) ART SPO Custom Back See Pg 8 172BU78 E2617 (ASAP II only) See appendix 1 172OD8 NonFolding Backrest 172OD9 Folding Backrest $ BU14 Omit Back. $15.00 Cane Angle Jay 3 Option 172BP40 Straight Back Post 172JB01 Towel Bar Depth 172B132 14" 172QT03 Shallow (NA with Upholstery backs.) 172B36 16" Deep (Extends 4" from back canes for deep 172B38 18" 172QT04 backs) 172B40 20" Back Cane 172B42 22" (Upholstery Height Measured pan to top of upholstery.) 172B44 24" Low (15.5") 172B1 Med (17.5")172B5 Tall (19.5") 172B9 172B140 26" Power Recline Backrest Preset Home Angle 172B42 22" Avail w/ standard curved and Jay3 MT (PA/PL backs) QK QK2 default QK3 172B44 24" 172B140 26" Back Type (Solid Recline) 172B141 27" 172BU83 Standard Curve back with 1.5" Foam cushion. 172B142 28" (Reduces Seat Depth) Push Handle Options 172JB03 JAY 3 BACK for 3.7 POWER RECLINE OPTIONS Jay 3 Contour. POSTERIOR [PA] E2613 E2614 POST & LATERAL [PL] E JP01 E JP02 E JP04 E2620 Backrest Frame Type 172BP BACKREST AND BACK OPTIONS for 3.7 POWER RECLINE (MPC) Backrest Frame Type Back Height Required for Standard Curved Recline Backs and Jay 3 172BT89 Power Recline (Power Recline Seat only) recline backs. 172BU84 $ JP03 172JP05 E2615 E o Bend Back Post (Avail. only w/ Upholstery or J3 Back) Jay J3 for Power Recline w/1.5" Foam Choose type below. (Reduces Seat Depth) J3 PA Back (2.2" of Contour Depth) Available 14"20" Wide (J3PAUTZYYXX) J3 PA Back (2.2" of Contour Depth) Available 22" Wide (J3PAUTZ22FX) J3 PL Back (3.0" of Contour Depth) Available 14"20" Wide (J3PLUTZYYXX) J3 PDL Back (6.0" of Contour Depth) Available 14"20" Wide (J3PDLUTZYYXX) J3 PDC Back (6.0" of Contour Depth) Available 14"20" Wide (J3PDCUTZYYXX) 9. BACKREST AND BACK OPTIONS for ASAP II (BC and SC) Back Type (Uphostery or Solid) $ $ $ $ $ $ BP56 Jay J3 for ASAP II (select OMIT above) Back Height Required for SPOT Curved, SPO Backs. (Limited combinations of widths) Measured from pan to top of solid back. (Limited combinations of widths) Measured from pan to top of solid back. 172BP55 Fixed "Cane" Handles. Height Adjustable Push Handles. w/2 utility hooks See J3 OF 172BP57 Omit push handles POSTERIOR & DEEP LATERAL [PDL] E2620 POSTERIOR & DEEP CONTOUR [PDC] E2620 $50.00 Jay 3 Back Height. Backs are height adjustable 172JR06 172JR01 172JR02 172JR03 172JR04 172JR05 MT for 22" tall back. (Mid Thoracic Short 15" shell) UT for 24" tall back. (Upper Thoracic Short 16.5" shell) UT for 26" tall back. (Upper Thoracic Med 18" shell) UT fot 27" tall back. (Upper Thoracic Tall 19.5" shell) SH for 28" tall back and widths 1420" (Shoulder Height 21" shell, ) SH for 2628" tall back and 22" wide seat (Shoulder Height 18" shell, ) Includes: 5 wedges, 2 lat shims, 2 post/lat pelvic, 1 lg lumbar, 1 flat shim, and 1 curved Jay 3 Width Back can be ordered 2" narrower than seat pan. Armrest will be adjusted to back width ordered. Future growth can be accomplised by replacing back with wider versions and adjusting arms outward. 172JQ01 172JQ02 172JQ03 172JQ04 Back width 14" (Use w/ 1416" wide seat) SPINEALIGN MINI FIT KIT 2 Back width 16" (Use w/ 1618" wide seat) Back width 18" (Use w/ 1820" wide seat) Back width 20" (Use w/ 2022" wide seat 172JS01 K0108 SPINEALIGN MINI FIT KIT 2 $ JQ05 Back width 22" (Use with 22" wide seat) Page 5

6 11. HEADREST OPTIONS Choose One Each. Headrest Mount Headrest Pad 172MH10 Axys Mount & Bracket $ HE65 E0955 Plush Head Support Pad 8" 172MH11 Cobra Mount and Bracket $ HE66 E0955 Plush Head Support Pad 10" 172MH1 Linx Mount and Bracket 172HE78 E0955 Plush Head Support Pad 14" 12. POSTURAL SUPPORTS LATERAL THORACIC SUPPORT (Swing Away) Swing Away Knee Adductor Supports Available on all Solid Backs. Available only with Fixed and Power Center Mount Legrests. LAT 4X4 S/A MOUNTS W/ 1" OFFSET PR $ Not available with Dual Post Arm Rests or 2point Locking Cantilever Arms 172ZV14 E0956 LATERAL 4X4 W/ 1" OFFSET PAIR $ Knee Adductor Supports LEFT (choose Pad and Arm) $ ZS07 LATERAL SWING AWAY MOUNT PAIR $ Pad Size LAT 4X5 S/A MOUNTS W/ 1" OFFSET PR $ KB5 E0956 Knee Adductor Pad SM Left 172ZV15 E0956 LATERAL 4X5 W/ 1" OFFSET PAIR $ KB7 E0956 Knee Adductor Pad LG Left 172ZS07 LATERAL SWING AWAY MOUNT PAIR $ S/A Arm Size LAT 4X6 S/A MOUNTS W/ 1" OFFSET PR $ XX04 Swing Away Short Left 172ZV16 E0956 LATERAL 4X6 W/ 1" OFFSET PAIR $ XX06 Swing Away Long Left 172ZS07 LATERAL SWING AWAY MOUNT PAIR $ Knee Adductor Supports RIGHT (choose Pad and Arm) $ LAT 6X4 S/A MOUNTS W/ 1" OFFSET PR $ Pad Size 172ZV17 172ZS07 E0956 LATERAL 6X4 W/ 1" OFFSET PAIR LATERAL SWING AWAY MOUNT PAIR $ $ KB6 172KB8 E0956 E0956 Knee Adductor Pad SM Right Knee Adductor Pad LG Right LAT 6X5 S/A MOUNTS W/ 1" OFFSET PR $ S/A Arm Size 172ZV18 172ZS07 E0956 LATERAL 6X5 W/ 1" OFFSET PAIR LATERAL SWING AWAY MOUNT PAIR $ $ XX05 172XX07 Swing Away Short Right Swing Away Long Right LAT 6X6 S/A MOUNTS W/ 1" OFFSET PR $ ZV19 E0956 LATERAL 6X6 W/ 1" OFFSET PAIR $ ZS07 LATERAL SWING AWAY MOUNT PAIR $ CHEST STRAP 172ZR03 E0960 Padded Chest Strap Long Thigh Support w/removable Mount Available with Cantilever Arms, NA with Manual Recline Back, Dual Post, Single Post or Cantilever w/ 2 pt Locking arms. SPOT Long Thigh Support Left $ TV2 E0956 Long Thigh Support Left $ TX1 Removable Mount Left SPOT Long Thigh Support Right $ TV1 E0956 Long Thigh Support Right $ TX2 Removable Mount Right Page 6

7 13. ARMREST AND ARMPAD OPTIONS 13A. Armrest options for ASAP II seating. Armrest Mounting for K0848 BC Models with ASAP II Dual Post Armrests 172EG01 Short Dual Post Flip Back 10" Height. 172EG09 Shrt Dual Post Flip Back HT Adj 10"15" 172EG21 Long Dual Post Flip Back 10" Height. 172EG23 Lng Dual Post Flip Back HT Adj 10"15" 172EG02 E0973 Shrt Dual Post Flip Back HT Adj 10"15" Cantilever Armrests 172EG22 Cantilever Armrests 172EG03 172EG04 E0973 Lng Dual Post Flip Back HT Adj 10"15" (Adjustable length arm pad included (choose Pad setting below, except for Low Arm Option) NA with Manual Recline Back E0973 E0973 Standard Cantilever Arm w/ 2 Point Locking Post. (9"10" Ht Range.) NA w/ seat depths below 16" Standard Cantilever Arm w/ 2 Point Locking Post. (11"12" Ht Range.) NA w/ seat depths below 16" 172EG05 E0973 STD Cantilever Arm 9"12" Ht Range 172EG06 E0973 Low Cantilever Arm 7"10" Ht Range (Choose ASAPII pad type and size below) Single Post Armrests 172EG07 E0973 Single Post Height Adjustable Std. 172EG08 E0973 Single Post Height Adjustable Low Armrest Mounting for K0856 SC Models with ASAP II. Dual Post Armrests (Adjustable length arm pad included (choose Pad setting below, except for Low Arm Option) NA with Manual Recline Back 172EG10 172EG11 172EG12 172EG13 Single Post Armrests Standard Cantilever Arm w/ 2 Point Locking Post. (9"10" Ht Range.) NA w/ seat depths below 16" Standard Cantilever Arm w/ 2 Point Locking Post. (11"12" Ht Range.) NA w/ seat depths below 16" STD Cantilever Arm 9"12" Ht Range Low Cantilever Arm 7"10" Ht Range (Choose ASAPII pad type and size below) 172EG14 Single Post Height Adjustable Std. 172EG15 Single Post Height Adjustable Low Armpad Options for ASAPII Pad Type / Size Options for Dual Post / Single Post / Low Cantilever Left Arm Pad () Right Arm Pad () 172AE01 Desk Length Waterfall (10") 172AE02 172AE03 Desk Length Standard (10") 172AB03 172AE04 Full Length Waterfall (14") NA w/low Cantilever arm Full Length Standard (14") NA w/low Cantilever arm 172AB01 172AB02 172AB04 Pad Setting Options for Standard Cantilever Arm Left Arm Pad () Right Arm Pad () 172AE11 Full Length Cantilever (14") 172AB11 172AE10 Desk Length Cantilever (10") 172AB10 13B. Armrest options for Power Recline Seating 172EG26 172EG27 172EG28 Armrest for Power Recline Seating. (Armrest width can be adjusted 2" narrower than seat) STD Cantilever/Reclining Arm 1014" Height Range Cantilever/Reclining Arm w/ 2 Point Locking Post. (10"12" Ht Range.) Cantilever/Reclining Arm w/ 2 Point Locking Post. (12"14" Ht Range.) Standard Reclining Armpad Left Arm Pad () Otto Bock Reclining Armpad (Power Recline Seat only) Reclining Armpad Options (Armpad can be angled inward 15 degrees) 172AE05 Reclining Arm Pad (16") 172AE08 E2209 SM Forearm Pads (8") 172AB08 172AE06 E2209 MD Forearm Pads (11.5") 172AB06 172AE07 E2209 LG Forearm Pads (14") Right Armpad () 172AB05 Left Arm Pad ($120.00) Right Armpad ($120.00) 172AB07 Otto Bock Hand Pad Options Left Hand Pad ($52.50) Right Hand Pad ($52.50) 172OL01 MD Flat Hand Pads (41/2" x 7") 172OR01 172OL02 LG Flat Hand Pads (51/2" x 9") 172OR02 Page 7

8 NonPowered Swing Away Legrests 172H95 172H2 172H94 172H138 E0990 Sold as Pairs 65 Swing Away (A,B,C) 70 Swing Away (A,B,C) 75 Tapered Swing Away (E) 172H6 90 Swing Away (B,C) (5.59") Manual ELR S/A (A,B,C,D) (Avail. with Fixed Centermount, choose below) 14. HANGERS AND FOOTRESTS FOR ASAP II Hanger and Extension Tubes Options (see footplate compatibility in the brackets) Footplate (Pair) $ F1 A Composite with Heel Loop (Pair) Composite Footplate B Adult Angle Adjust w/heel Loop for use with 65, 70 hanger and ELR (Pair) 172F282 K0040 Adult Angle Adjustable Footplate 172HL10 E0951 Heel Loop 172HL1 E0951 Heel Loop $ $ $45.00 Powered Elevating Legrests B Adult Angle Adjust w/heel Loop for use with 90 hanger (Pair) $ H125 K0108 Power Centermount ELR w/ Articulation (Leg length indepedant actuator for transfer assist) (F) $2, F285 K0040 Adult Angle Adjustable Footplate $ HL10 E0951 Heel Loop $ H126 E1010 Omit Hangers. 172F287 D Aluminum (Pair) 172H144 Omit Hangers E One Piece Angle Adjust Footplate $ NOTE: Not all extension tube will be available; depending on the seat height, some extension tube options may not offer enough ground clearance. 172H135 Fixed Center Mount Long 172F286 Hanger Extensions. (See range listed in matrix below) 172LS13 K0038 Leg Strap 172E16 K0037 High Mount Hanger $ F315 K0040 CMT Angle Adjustable Footplates $ E1 Short 172F279 Omit Footplate and extension tube 172E2 Medium 172E5 S/A Power ELR w/ Articulation (B) Pair (N/A for 12" or 13" wide) (Avail. with Fixed Centermount, choose below) Fixed Center Mount Legrests (includes footplate) 172H134 Fixed Center Mount Short Long $2, E21 Omit Extension C Kids Angle Adjust w/leg Strap for use with 65 and $ hanger (Pair) 172F283 K0040 Kids Angle Adjustable Footplate $ LS13 172LS13 172F284 K0040 One piece Angle Adjustable Footplate $ Footrest Accessories F Centermount Single/Dual Footplate (Single Footplate can be unlocked to form individual footplates) 1725A01 E0952 Toe Loop (Pair) Only avail on (opt B). $ LS14 K0038 K0040 Kids Angle Adjustable Footplate $ K0038 Leg Strap C Kids Angle Adjust w/leg Strap for use with 90 hanger(pair) K0038 Leg Strap Extra Leg Strap $ $ Lower Leg Length Matrix (measured seat pan to the top of the footplate surface) Hanger Type High Mount Short Medium 65 Swing Away 714" " " 70 Swing Away 714" " " 75 Tapered S/A 714" " " 90 Swing Away 5.59" Footplate mounts to front of hanger. 90 Swing Away Manual ELR S/A " " 1721" Manual ELR S/A Power ELR S/A 1214" 1417" 1518" 75 Tapered S/A " Power ELR S/A Fixed Cntrmnt 12.5"15.5" 14.5"19.5" Fixed Cntrmnt Power Cntrmnt 14"18" Power Cntrmnt Long Hanger Type " 65 Swing Away " 70 Swing Away Footplate Matrix A B C D E F X X X X X X X X X X X X X X Single Ftplate included X 14. ACCESSORIES Wheelchair Tray Table NA with Otto Bock Armrest. 1727A01 E0950 TRAY TABLE SM TUFFAK A02 E0950 TRAY TABLE MED TUFFAK 1517 PWR 1727A03 E0950 TRAY TABLE LRG TUFFAK 18 PWR Backpack 172A1 Black Utility $ A2 Black/Charcoal Kids $50.00 Positioning Belt Select for any style seat 172EJ01 172EJ02 172EJ03 E0978 E0978 Auto Style Buckle Belt 2" Aircraft Buckle Belt 2" Aircraft Buckle Padded BUILT 4 ME OPTIONS To Inquire about any unique customization for Quickie products, contact: Phone: (800) , Option #3 or Fax: (800) $35.00 $65.00 Page 8

9 ART SPO CUSTOM CURVED BACKREST Posterior Positioning Backrest (E2617) EIPW11, November 2013 Account: Date: PO#: Buyer: Marked For: Ship To: Name: Address: City,State,Zip: Phone: 1. Backrest Type SPO E2617 CUSTOM Rectangular Back (Dia / Fig. A) $ CUSTOM 172GI01 Complete only Dimensions A & B below Foam components similar to Diagram D SPO E2617 IShape Back (Diag./ Fig. B) $ IBack 172GI02 Complete Dimensions A E Below Foam components similar to Diagram D DIAGRAM A DIAGRAM B Figure A Custom Rectangular Back Figure B I Shape Back BACK REST TYPE DIMENSIONS Dimension A BACK HEIGHT Dimension B BACK WIDTH (must be same as Base Width) Dimension C IBACK ONLY Dimension D IBACK ONLY Dimension E IBACK ONLY WEBSITE: Specifications are subject to change without notice. Copyright REV G Page 9

10 ART SPO CUSTOM CURVED BACKREST Posterior Positioning Backrest (E2617) EIPW11, November Back Relief Back Relief Dimensions SPO Scapular E2617 Scapular CutOut Back (Diagram C) Complete Dimensions A, B, F & G Foam components similar to Diagram D $1, Dimension A BACK HEIGHT Dimension B BACK WIDTH (must be same as Base Width) Dimension F Dimension G 172GI03 Figure C Scapular Relief Back 1417 Not Available Not Available Not Available Diagram C Scapular Relief Back Diagram D Foam Components Custom Foam Thickness Available on all Backs 1" Standard 2.5" 1.5" 3" 2" WEBSITE: Specifications are subject to change without notice. Copyright REV G Page 10