MEDIchair Northern BC nd Avenue Prince George, British Columbia V2L 3A6 Toll Free
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1 MEDIchair Northern BC nd Avenue Prince George, British Columbia V2L 3A6 Toll Free
2 BC Ministry of Health A Cheat Sheet for Clinicians Included Features for a Basic Wheelchair, Basic Modified Wheelchair and Specialized Wheelchair Wheelchair Feature/Attribute Light-weight frame (typically <35 lbs) Variable seat heights (including super low) Upholstery/fabric back Adjustable padded arm rests Solid, pneumatic or semi-pneumatic rear wheels Front casters (any size) Wheel brakes with extensions as necessary Anti-tippers Swing-away foot rests Rear handles Seat belt for bus transportation Weight capacity up to kg/250 lbs Reclining back Padded backs, contoured backs, supportive backs, back positioning devices, lateral back supports, lumbar supports Swing-away arm rests Lap trays (full or half), lap cushions, extended arm rests, elevating arm rests, comfort or gel arm rests, arm trays, modified arm rests, safety positioners Anti-roll back devices Articulating (i.e. elevating) foot rests Calf pads/supports, foot/leg troughs, footrest extenders, leg supports, leg straps, knee adductors, foot cradles, foot supports, amputee boards, toe straps Lap belts, safety belts, retainer straps, pelvic positioning devices, knee/thigh belts Chest harnesses, torso supports, posture supports, Head supports, neck supports Wheel grip covers, grip attachments Rear handle extensions Wheelchair alarms Oxygen holders, cane/crutch holders Flags, bags, drink holders, incontinence holders/bags Weight capacity >113.4 kg/250 lbs Tilt-in-space capacity Power mobility, accessories with electrical components Basic Wheelchair Modified Basic Wheelchair - Included in definition - Not Included in definition N.B. While each indicates that the feature is included in the definition, every feature may not be necessary for every wheelchair prescribed to every resident. Specialized Wheelchair Items in yellow can be charged to the resident if not supplied by the care provider
3 Basic Wheelchair Bid Work Sheet HMEDA Member Name/Address: B.C. Ltd O/A MEDIchair Northern B.C. Contact Person: Christopher Gobbi Phone/ Phone: Delivery and MDEL Information Our company is able to deliver and service proposed products within the following geographic boundaries: Prince George, West to Smithers, South to 100 Mile House, North to Fort St. John (inclusive of all communities within these boundaries) Our company has a valid MDEL. Our licence number is: 3054 It has come to our attention that the Ministry of Health Cheat Sheet for a basic wheelchair does not include a cushion. We expect that every basic wheelchair provided under this policy will require at least a 2" thick foam cushion with a fluid resistant cover. Please be sure to add details and pricing for the supply of a basic wheelchair cushion with each of the wheelchair options you propose in your bid. Your cushions might best be listed separately since some care homes may ask you to provide a specific type of cushion when placing orders. New Basic Wheelchairs Product Model Name Option 1 Invacare Myon and Pride Synergy Cushion Myon Folding Wheelchair Variable Depths and Widths as specified Variable Seat to Floor Height as specified Active Axle mag wheels Adj. Angle back and Adj. Height canes 5 x 1 ½ or 6 casters Aluminum anodized hand rims Quick release axle Flip up composite footplates Contour Tension Adjustable Back Myon push to lock wheels with extensions Flip back adjustable full length arms 70 Degree swing in/out hangers Rear Anti-tippers Pride Synergy Cushion Deep contoured, high density molded foam base Coccyx and sacral relief Stretch incontinence cover
4 Comments re compliance with Basic Wheelchair Cheat Sheet meet all Modified Basic Wheelchair specs. MYON comes standard with tension adjustable back rest as well as depth adjustable seat and upholstery. Initial Product set-up charge/wheelchair: Included in price Included for 2 years provided that in areas outside Prince George the adjustments can be done on regularly scheduled trips. Additional 1 year Warranty to be provided for any damages not caused by user provided that in areas outside of Prince George the repairs can be done on regularly scheduled trips Unit Price for Qty Unit Price for Qty Unit Price for Qty Product Model Name Option 2 Sunrise Breezy 600 and Pride Synergy Cushion Sunrise Breezy 600 Folding with Pride Synergy Cushion Variable Depths and Widths as Specified seat - 20 seat upcharge of $ Variable Seat to Floor Height as specified Super Low has upcharge based on seat to floor height rear wheels 5-8 polyurethane casters Aluminum anodized hand rims Flip up composite footplates Adjustable Back with Back Canes Flip back adjustable full length arms Swing away hangers Rear Anti-tippers Pride Synergy Cushion Deep contoured, high density molded foam base Coccyx and sacral relief Stretch incontinence cover Comments re compliance with Basic Wheelchair Cheat Sheet meet all Modified Basic Wheelchair specs. Initial Product set-up charge/wheelchair: Included in price Included for 2 years provided that in areas outside Prince George the adjustments can be done on a regularly scheduled trip.
5 Additional 1 year Warranty to be provided for any damages not caused by user provided that in areas outside of Prince George the repairs can be done on regularly scheduled trips. Price for Qty Price for Qty Price for Qty Product Model Name Option 3 Motion Composites Move and Pride Synergy Cushion Motion Composites Folding Move Variable Depths and Widths seat Width seat Depth 20 Seat Width Upcharge Flip Back Height Adjustable full length arm rests 70 degree swing-away Footrests Composite Foot plates with heel loops 5-8 composite casters Mag Wheels Aluminum Anodized Hand rims Quick Release Axle Push to Lock wheel locks Anti-tippers Comments re compliance with Basic Wheelchair Cheat Sheet meet all Modified Basic Wheelchair specs. Initial Product set-up charge/wheelchair: included in price Included for 2 years provided that in areas outside Prince George the adjustments can be done on regularly scheduled trips. Additional 1 year Warranty to be provided for any damages not caused by user provided that in areas outside of Prince George the repairs can be done on regularly scheduled trips. Price for Qty 5-10 $ Price for Qty $ Price for Qty
6 Used Wheelchairs Product Model Name Option 1 *****USED WHEELCHAIRS MAY BE AVAILABLE PLEASE CONTACT FOR AVAILABILITY AND PRICING***** Comments re compliance with Basic Wheelchair Cheat Sheet Initial Product set-up charge/wheelchair: Price for Qty 5-10 Price for Qty Price for Qty 20 + Rental Wheelchairs Product Model Name Option 1 Invacare Myon and Pride Synergy Cushion Myon Folding Wheelchair Variable Depths and Widths as specified Variable Seat to Floor Height as specified Active Axle mag wheels Adj. Angle back and Adj. Height canes 5 x 1 ½ or 6 casters Aluminum anodized hand rims Quick release axle flip up composite footplates Contour Tension Adjustable Back Myon push to lock wheels with extensions Flip back adjustable full length arms 70 Degree straight swing in/out hangers Rear Anti-tippers Pride Synergy Cushion Deep contoured, high density molded foam base Coccyx and sacral relief Stretch incontinence cover
7 Comments re compliance with Basic Wheelchair Cheat Sheet meet all Modified Basic Wheelchair specs. Initial Product set-up charge/wheelchair: Included in rental Included in rental rate provided the adjustments can be done on regularly scheduled trip if outside of Prince George Warranty and maintenance included in rental price excluding any user caused damage provided that in areas outside of Prince George work can be done on regularly scheduled trips. Price for Qty per month (min. 6 month rental for initial request) Price for Qty per month(min. 6 month rental for initial request) Price for Qty per month(min. 6 month rental for initial request) Additional comments These quotes are based on broad information and may be more customizable to your specific needs, please feel free to contact us at any time to discuss any aspect of the quote or any additional options that may be available. No signature is required for this bid. As stated in the outline, this bid is not a binding document. Bidders are supplying this information and BC Care Provider Association members are receiving this information in an effort to help both parties gain an understanding of what products might be available for use as a basic wheelchair and what costs are involved. It is anticipated BC Care Provider Members may use this information in selecting suppliers and subsequently obtaining products needed in an effort to meet Ministry of Health policy.
BC MEDEQUIP HOME HEALTH CARE LTD SPRINGER AVE, BURNABY, BC
Basic Wheelchair Bid Work Sheet HMEDA Member Name/Address: BC MEDEQUIP HOME HEALTH CARE LTD. 2230 Springer Avenue, Burnaby, BC, V5B 3M7 Contact Person: ANDRE MONTAGANO Phone/e-mail: 604-888-8811 andre@bcmedequip.com
Delivery and MDEL Information Our company is able to deliver and service proposed products within the following geographic boundaries:
HMEDA Member Name/Address: PG Surg Med Ltd. 1749 Lyon St Prince George, BC V2N 1T3 Contact Person: Russ Pratt, President and Jennifer Erickson, Rehab Coordinator Phone/e-mail: 250-564-2240 or 1-800- 663-2963
Delivery and MDEL Information Our company is able to deliver and service proposed products within the following geographic boundaries:
HMEDA Member Name/Address: Surg Med Ltd. - Vernon 4026 25 th Ave Vernon, BC V1T 7G9 PH: 250-549-7288 or 1-866-942-7288 Contact Person: Russ Pratt, President and Jennifer Erickson, Rehab Coordinator Phone/e-mail:
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Standard Base Price: 618
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BINGO Evolution rehab pushchair Size 2 for children at the age of approx. 4-10 years Crash tested according to ISO 7176-19 and ANSI/RESNA WC/Vol.1. - Section 19 Order form incl. Exportprices ( ) valid
USA Parts List BENTLEY
USA Parts List BENTLEY Effective January 1, 2018. Prices in U.S. Dollars. Prices and descriptions contained in this manual are subject to change without prior notice. Bentley Frame-Seat Pan Floor Jack
NXT Pediatric. Manual Wheelchair. Transport Optional Base
Pediatric Manual Wheelchair Date: Buyer: Company: Email: Quote Order PO# Location: Phone: Fax: Transport Optional Base Folding (E1234) NXT-30300 $2800 Transport Optional Note: Transportation Option selected
Account Number: Provider Name: Contact:
Discount: Terms: Freight: Taken By: Quantum Rehab A Division of Pride Mobility Products Corporation 82 Susquehanna Ave., Exeter, PA 8643 Phone: (866)800-2002 Fax: (866) 707-3422 DME providers are responsible
Note Section. Set-to-Spec. This section must be filled out, otherwise the selection will default to the mid-range measurements.
AADL W592/W991 Quantum Q6 Edge 2.0 with TB3 Power Positioning FOR AADL USE ONLY Pride Mobility Products Co. 5096 South Service Rd, Beamsville, ON, L0R 1B3 Phone: 888-570-1113 Fax: 866-514-1303 Discount:
NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS STABLE
Invacare MyOn Active HD Folding Wheelchair AADL Customers Only AADL # W155 Effective October 1, 2018 NAME PHONE NO ACCOUNT# P.O. DATE ADDRESS FRAME SELECTION FRAME TYPE MYONAC MyOn Active Folding Wheelchair
SHIPPING INFORMATION Provider Acct #:
May 2014 Kids ROCK TM Size 2 Order Form Maximum Weight Capacity 115 lbs. 14"Wx16"Dx22"H Seating Capacity. Customer Service: 800-800-8586 (toll free) Email: orders@pridemobility.com Date: Quote Order SHIPPING
Phone: Nov-17
By Ormesa New 201 Growth Parkway Angola, IN 46703 U.S Suggested Retail Price List in USD Phone: 800-327-0681 Nov-17 Fax: 260-665-3047 Email: iim@mobility-usa.com Quote: P.O. www.mobility-usa.com Bill To
Shower commode chairs
Ocean, Ocean XL, Ocean Vip, Ocean ual Vip, The Ocean series of shower commode chairs offers the right model for all demands. www.clarkehealthcare.com 888-347-4537 17 Ocean Stable, stainless steel frame
Phone: Jan 17. Fax: usa.com Quote: P.O. usa.com Bill To
By Ormesa New 201 Growth Parkway Angola, IN 46703 U.S Suggested Retail Price List Phone: 800 327 0681 Jan 17 Fax: 260 665 3047 Email: iim@mobility usa.com Quote: P.O. www.mobility usa.com Bill To Dealer:
Canada Quote / Order Form Combi
Canada Quote / Order Form Combi 7105 Northland Terrace Brooklyn Park, MN 55428 Ph# 1-888-538-6872- Ext 2 Fax# 763-582-0442 Amy Jorgensen-Inside Sales AmyJ@danetechnologies.com www.levousa.com Dealer Information
USA Parts List FUZE T20
USA Parts List FUZE T20 Effective January 1, 2018. Prices in U.S. Dollars. Prices and descriptions contained in this manual are subject to change without prior notice. Fuze T20 Frame-Seat Pan Cross Bar
Order no.: ... Date Signature. Posterior seat height
Start M6 Junior Scripted Order no.: Start M6 Junior Lightweight wheelchair Article number: 480F53=60000_K Provide estimate only Order Billing address/customer number Ottobock START_M6_647F263=EN-05-1510
champion carbon Customer weight = Kg Code X Description Dealer SEATING CHOICE DDF0204 küschall Champion Carbon 85 Frame Angle
Invacare Ltd Manual Wheelchair Pencoed Technology Park Dealer Prescription Form Pencoed. CF35 5AQ LPF1U2CHAMPION211114D Tel: 01656 776222 Fax: 01656 776220 LPF0015Z email: ordersuk@invacare.com January
2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) PRO-CG. Adult Manual Wheelchair
PRO-CG Adult Manual Wheelchair email: customerservice@freedomdesigns.com TM SE Clear Form Email Form to Customer Service Date: Buyer: Company: Email: Quote Order PO# Location: Phone: Fax: Notice: A seating
4.1 MOVE. ORDER FORM - CANADA Ship to: Name: Address: Account: Vendor: Date: Ordered by: Marked for: User manual: PO: Postal Code: Phone:
519, J-Oswald Forest, suite 101 Saint-Roch-de-l'Achigan, QC, Canada J0K 3H0 T.450 588-6555 1 866 650-6555 F.450 588-0200 www.motioncomposites.com Account: Vendor: Date: Ordered by: Email: Marked for: User
SIDEFRAME (FIXED ARM), CROSSBRACE, ARM PAD KIT...3 SIDEFRAME (DETACHABLE ARM), CROSSBRACE...4 ARM, DETACHABLE...5 CASTER...5 REAR WHEEL...
PARTS CATALOG CONTENTS SIDEFRAME (FIXED ARM), CROSSBRACE, ARM PAD KIT... SIDEFRAME (DETACHABLE ARM), CROSSBRACE... ARM, DETACHABLE...5 CASTER...5 REAR WHEEL...5 FRONT RIGGING, DETACHABLE...6 UPHOLSTERY
SHIPPING INFORMATION Provider Acct #:
May 2014 Kid's ROCK TM Size 3 Order Form Maximum Weight Capacity 215 lbs. 17Wx20Dx26H Seating Capacity Customer Service: 800-800-8586 (toll free) Email: orders@pridemobility.com Date: Quote Order SHIPPING
W H E E L C H A I R S
WHEELCHAIRS Value: Graham-Field is known for a broad product offering at affordable pricing, without sacrifice to quality. Like you, we understand that the cost of a product is more than a price tag. The
Manual Wheelchair Pencoed Technology Park. DEALER Prescription form Pencoed. CF35 5AQ. LPF1U2ULTRALIGHT211113D Tel: Fax:
Invacare Ltd Manual Wheelchair Pencoed Technology Park DEALER Prescription form Pencoed. CF35 5AQ LPF1U2ULTRALIGHT211113D Tel: 01656 776222 Fax: 01656 776220 LPF0020X email: ordersuk@invacare.com January
Index. By Chair Model. Accessory Cushions & Parts. Seat & Back Pads. Positioning Belts. Trays. Footrests. Cylinders & Cables. Stabilizers/Anti-Tippers
Parts & Accessories Index By Chair Model Accessory Cushions & Parts Seat & Back Pads Positioning Belts Trays Footrests Cylinders & Cables Stabilizers/Anti-Tippers Page Elite 2 MIDLINE 3 30VT 4 Pedal Chair
q Little Wave Flip XP - Rigid Base KF-XPRIGID $
Phone 0800 5 222 Fax 0800 275 65 Effective /06/207 Funder: Account Number: Date: Quote PO Number: Therapist: Marked For: Little Wave Flip XP - Rigid Base KF-XPRIGID $ 9.8kg weight capacity. One time free
R82 Wombat Living. CAD Retail Price List/ Order Form. Account #: Purchase Order No.: Date: Wombat Living Standard Features:
Account #: Purchase Order No.: Date: Contact: R82 Wombat Living CAD Retail Price List/ Order Form Mark For: Bill To: Address: City/State/Zip: Phone: Email Ship To: Address: City/State/Zip: Phone: Wombat
SHIPPING INFORMATION. Order
Size 3 Order Form MASS 2014 Maximum Weight Capacity 215 lbs. 17Wx20Dx26H Seating Capacity Pride Mobility Products Aust Pty Ltd 20-24 Apollo Drive Hallam VIC 3803 Ph: 03 8770 9600 Fax: 03 9703 2960 Date:
2241 N Madera Rd Simi Valley, CA Phone: (800) Fax: (888) P.R.O. CG. Adult Manual Wheelchair
P.R.O. CG Adult Manual Wheelchair TM SE 2241 N Madera Rd Simi Valley, CA 93065 Phone: (800) 331-8551 Fax: (888) 582-1509 www.freedomdesigns.com email: customerservice@freedomdesigns.com Date: Buyer: Company:
Invacare. Family Compatibility Portfolio Optimize your business with an all-in-one solution. Jan
Invacare Family Compatibility Portfolio 2012 Optimize your business with an all-in-one solution. Content Introduction 3 How to use this publication 3 Pictograms 3 Technical information 4 Products overview
Pronto M50 Pronto M51 with SureStep (Before 1/20/05)
Parts Catalog Issued: Aug 30, 2018 Pronto M50 Pronto M51 with SureStep (Before 1/20/05) MWD Power Wheelchairs Parts Catalog Usage Guide The information contained in this document is subject to change without
UNMATCHED PERFORMANCE. THE PROFESSIONALS BEST CHOICE IN FOLDING ULTRA- LIGHTWEIGHT ABILITY.
CATALYST UNMATCHED PERFORMANCE. THE PROFESSIONALS BEST CHOICE IN FOLDING ULTRA- LIGHTWEIGHT ABILITY. INNOVATIVE AND PATENTED FRAME DESIGN Catalyst frames are constructed from 7000 series aluminum. A stronger
SHIPPING INFORMATION Provider Acct #: Address: ST: ZIP:
May 2014 Kids FAST Order Form Maximum Weight Capacity 80 lbs. 12"Wx14.5"Dx19.5"H Seating Capacity. Customer Service: 800-800-8586 (toll free) Email: orders@pridemobility.com Date: Quote Order SHIPPING
champion Standard Base Price 1,875 Standard Features
Invacare Ltd Manual Wheelchair Pencoed Technology Park Dealer Prescription Form Pencoed. CF35 5AQ LPF1U2CHAMPION290514D Tel: 01656 776222 Fax: 01656 776220 LPF0015Z email: ordersuk@invacare.com January
Condor Script Form Folding Frame Day Wheelchair 90050
90050 To Order Fill in the frame dimensions and features required. For variations describe in detail on a separate page. If you have any further questions contact us at the address at the bottom of the
Positioning Components Order Form - ODJFS Only
Quantum Rehab 401 York Ave., Duryea, PA 18642 Phone: 866-800-2002 Fax: 866-707-3422 Email: quantumorders@pridemobility.com Positioning Components Order Form - ODJFS Only Account Number: Date: Provider