R82 Caribou - E0641. USD Retail Price List/ Order Form. Account #: Purchase Order No.:
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1 Account #: Purchase Order No.: Contact: R82 Caribou - E0641 USD Retail Price List/ Order Form Date: Mark For: Bill To: Address: City/State/Zip: Phone: Ship To: Address: City/State/Zip: Phone: US Configuration Caribou Top Pad/Shoulder Support Cross Straps/Back Support Chest Strap Head Support Extra Cushion Hip/Side Support Knee Support/Pommel with Strap Tray Measurements A (Total Height) B (Shoulder Height) C (Chest Height) D (Top of Pelvis) D1(Buttock Height) D2 (Below Knee) E (Chest Width) F (Shoulder Width) G (Pelvis Width) Age Weight Effective: 06/01/ Rev 4 Size 1 Size 2 Size 3 Size 4 Inches Inches Inches Inches Frame width (G) 20" 22½" 25½" 29¼" Frame length (H) 29¼" 36" 43¼" 43¼" Height, vertical (I) 18-22½" 20¾-25¼" 26¾-31" 34¾-39" Height, horizontal (I1) 27½" 27½" 31½" 31½" Height from floor to frame (I2) 5" 5" 5" 5" Basis plate width, top-bottom (J-J1) 9¾-12½" 11¾-15" 13¾-18" 15¾-21¾" Basis plate height (K) 17" 19¾" 25½" 33½" Angling 0-87º 0-87º 0-87º 0-87º Foot plate angling º º º º Weight, wo/power 45.2 lbs. 53 lbs lbs lbs. Weight, w/power 49.6 lbs lbs lbs lbs. Max load 88.2 lbs lbs lbs. 220½" Approximate total user height 22-42" 32-52" 42-60" 52-72"
2 Caribou Standard Features Sizes 1, 2, 3 and 4 4" Locking Castors Contoured Top Plate Tilt: From Vertical to Horizontal Height and Angle Adjustable 2-Piece Footrest Description Size Part No. USD Price Important: For sizes 3 and 4 it is recommended to use the power version to ease the tilting; see below Caribou Base w/ 2-Piece Footrest FP $2,730 Caribou Base w/ 2-Piece Footrest FP $2,830 Caribou Base w/ 2-Piece Footrest FP $3,135 Caribou Base w/ 2-Piece Footrest FP $3,645 Description Size Part No. USD Price Caribou Base with Power Actuator ELFP $4,260 Caribou Base with Power Actuator ELFP $4,360 Caribou Base with Power Actuator ELFP $4,665 Caribou Base with Power Actuator ELFP $5,175. Non-returnable item (Sz 1 and 2) Required, must select one: Top Pad W1:6, W2:7, H:7¾ N/C Top Pad W1:7½, W2:9, H:9¾ N/C Top Pad W1:8¾, W2:10½, H:12½ N/C Top Pad W1:9¾, W2:12¼ H:15¾ N/C Top Pad size must match Shoulder Support size Head Pad W: 6", H: 7½" 1, $505 Head Pad W: 8", H: 9½" 3, $505 Extra Cushion (Ea.) W:9¾ x H:3 One Size $230 Extra Cushion (Ea.) W:11¾ x H:4 One Size $230 Extra Cushion (Ea.) W:13¾ x H:4 One Size $250 Extra Cushion (Ea.) W:15¾ x H:4 One Size $250 Accessories XX = 60 (Black) Cross Vest (Ea.) A: 5 x B:½ x C: XX $190 Cross Vest (Ea.) A: 5½ x B:½ x C: XX $190 Cross Vest (Ea.) A: 6¼ x B:2½ x C:15¼ XX $190 Neoprene Vest (Ea.) A:7 x B:5½ x C:4 x D:4½ $200 Neoprene Vest (Ea.) A:10½ x B:11 x C:6½ x D:5¾ $200 Neoprene Vest (Ea.) A:11¼ x B:9 x C:7 x D:6½ $200 Chest Belt, Upholstered (Ea.) $270 Chest Belt, Upholstered (Ea.) $270 Chest Belt, Upholstered (Ea.) $270 2 of 5
3 Fix-Locks, Black, Bag of 6 Pcs One Size $42 Required for use of Vests Other types of vests and belts available, please see Vest and Belts Order Form Chest Strap (Ea.) W: 16½-24¾ 1, $120 Chest Strap (Ea.) W: 19-30¼ $120 Chest Strap (Ea.) W: 22¾-37¾ $120 Note: A chest strap is not included as standard, quantity of two straps is recommended. Cross Straps (Pr.) 15-19¼ $280 Cross Straps (Pr.) 17-21½ $280 Cross Straps (Pr.) 20¾-27½ $295 Cross Straps (Pr.) 24¾-33¾ $295 (Size 4) Side Supports, Fixed, Type 7 (Pr.) Pad: x 4.72" 1, $250 Side Supports, Fixed, Type 5 (Pr.) Pad: 6.3 x 5.9" 3, $300 Side Supports, size 1 (Pr.) L: 5½ X H:5½ x W:3¾ One Size $285 Side Supports, size 2 (Pr.) L: 6½ X H:7 x W:5 One Size $285 Side Supports, size 3 (Pr.) L: 7¾ H:7 x W:5 One Size $285 Width between laterals on torso pad (min-max) Size 1: 4" to 9" Size 2: 6½" to 14" Size 3: 12" to 18" Lateral Support Strap (Ea.) 10-12½" $51 Lateral Support Strap (Ea.) 13-16" $51 Lateral Support Strap (Ea.) 13½-19¾" $51 Shoulder Support (Pr.) W:3, H:7½, D: $255 Shoulder Support (Pr.) W:3¼ H:9¾, D: $255 Shoulder Support (Pr.) W:4, H:12½, D: $255 Shoulder Support (Pr.) W:4¼H:15¼ D: $255 Shoulder Support size must match Top Pad size. Upper Arm Support, Small 1, $375 Upper Arm Support, Large 3, $400 Wedges for Side Slots (Pr.) $16 Wedges for Side Slots (Pr.) $16 Wedges for Side Slots (Pr.) $16 (All Sizes) Back Support (Ea.) 1, $295 Back Support (Ea.) 3, $300 (Sizes 1 & 2) 3 of 5
4 Turtle Bar System A: 10, B: 4-8½ Long $230 Required with all Head Supports Anatomic Head Support A:5½ x B:5½ x C:9½ Small $255 Head Support Cover (Required) Small N/C Anatomic Head Support A:6 x B:5½ x C:10 Medium $255 Head Support Cover (Required) Medium N/C Anatomic Head Support A:6½ x B:5½ x C:12½ Large $255 Head Support Cover (Required) Large N/C Turtle Bar System Short or Long Required; or Other types of headrest available, please see Head Supports Order Form Pommel, Size 1 (Ea.) W1:2,W2:2¾,H:6,D:3½ One Size $135 Pommel, Size 2 (Ea.) W1:6,W2:2¾,H:6,D:6¾ One Size $135 Strap for Pommel, Sz 1 (Ea.) L: " One Size $145 Strap for Pommel, Sz 2 (Ea.) L: ½" One Size $145 Knee Support, Fixed, sz 1 1, $385 Knee Support, Hinged, Fixed, sz 1 1, $535 Knee Support, Fixed, sz 2 ** 3, $385 Knee Support, Hinged, Fixed, sz 2 3, $535 Knee Support, Swing-Away, sz 1 1, $665 Knee Support, Hinged, Swing-Away, sz 1 1, $815 Knee Support, Swing-Away, sz 2 3, $665 Knee Support, Hinged, Swing-Away, sz 2 3, $815 Formed Footplates (Pr.) L: 8½ 1, $165 Formed Footplates (Pr.) L: 9¼" 3, $165 Foot Straps, Plastic Lock (Pr.) Max: 22", A: 13½-20½ One Size $36 Foot Straps, Velcro (Pr.) One Size $51 Heel Support for Parted Foot Support (Pr.) 1, $56 Heel Support for Parted Foot Support (Pr.) 3, $56 Upholstered Ankle Straps (Pr.) $185 Upholstered Ankle Straps (Pr.) $185 Upholstered Ankle Straps (Pr.) $185 4 of 5
5 Both Trays can be used in Prone and Supine Position Tray, Plastic, with Bowl & Cover (Ea.) 1, $560 Tray, Plastic, with Bowl & Cover (Ea.) 3, $560 For Supine Use Only Low Mount Kit for Plastic Tray One Size KIT $205 Plastic Tray required ( or ) Armrest for Plastic Tray One Size $160 Toybar for Plastic Tray One Size $240 Grip Handle for Tray One Size $405 Helper's Handle One Size U $140 For moving and tilting the Caribou Spare Parts Power Kit, Complete (Ea.) 1, $2,320 Power Kit, Complete (Ea.) $1,588 Power Kit, Complete (Ea.) $1,588 Plug for USA/Canada (Ea.) One Size $26 Batteries for Caribou with Power (Pr.) One Size $305 Both batteries must be charged at the same time HCPCS codes are provided for your convenience and are NOT to be considered billing or legal advice. Providers are responsible for insuring that all appropriate billing codes are used when submitting claims. Proper use of HCPCS codes does not insure coverage or payment. Contact the appropriate payer for coverage information. For shipping rates, please call E Independence Blvd, Matthews, NC Web: Prices in USD & is subject to change without notice 5 of 5
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