Quickie Q7 Adjustable SUBMIT August 2015 EIR4 Mark Fr: Submitting fr: Date: PO#: Qute Order Dealer Acct #: Dealer: ADDITIONAL SHIPPING INFORMATION Dealer Cntact: Ship T: Dealer Address: Attentin: Dealer City: ST: Dealer Phne: ( Address: ZIP: Fax: ( Address: Cnfirmatin Email: Ship T City: Cnfirm Via: Fax ST: Ship T Phne: ( Email ZIP: 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. a Optin # HCPCS Definitin Price a Optin # HCPCS Definitin Price 1. FRAME STYLE & SETUP Base Mdel 186WM60 K0005 Frame Inset Per Side Quickie Q7 - Adjustable (265 lbs $2,425.00 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 $625.00 Package Price $535.00 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 75 186FA8 80 186FA2 85 $100.00 $600.00 $510.00 Transit 186TO45 Transit Figure 1 $315.00 Figure 2 See FIGURE 2 Frame Inset is the distance frm the utside f the seat tube t the utside f the ftrest. 186FF1 0" 186FF2 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. Caster Husing Psitin See FIGURE 4 186LH01 186LH02 186LH03 1 Suggested fr 3" & 4" casters. Fr 2" Inset NA w/ setting 1 2 Suggested fr 5" & 6" casters. 3 NA w/ 6" casters 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 Figure 3 Figure 4 Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US LLC. Q7, MK-100021 Rev F Page 1
1. FRAME STYLE & SETUP (CONT. Depth Adjustable Backrest (Optinal See Figure 5 Depth Adjust Backrest extends the frame rear f the seat sling, select a factry setting. 186DP02 186DP03 186DP04 0 Backrest at standard psitin, field adjustable t -1" r -2" Figure 6 Figure 7 $165.00-1 Backrest -1" ffset, field adjustable t flush r -2" $165.00-2 Backrest -2" ffset, field adjustable t flush r -1" $165.00 Figure 5 Seating Systems Standard Seat Sling 186OP01 186OP02 Available 14" t 18" Width and Depth. Ultra Seat Sling will be ~1/4" less than requested seat height value. 186OP04 Omit Seat Sling Ultra Seat Sling $100.00 Seat Width See FIGURE 6 Measure frm utside f seat tube t the utside f ppsite seat tube. 186S3 186S4 186S5 186S6 186S7 12" 13" 14" 15" 16" 186S8 186S9 186S10 186S48 17" 18" 19" 20" (E2201 $500.00 JAY Cushins (Optinal T rder any JAY cushins n-chair, please see the JAY price list. Cushin name r part number must be filled ut with desired width and depth JAY Bundled Cushin 186JC20 Cushin Name r Part # Price List Width: Depth: Seat Depth See FIGURE 7 Measure frm frnt f back pst t frnt edge f seat sling. Seat sling is 1" shrter than depth rdered, but actual seat depth will remain the same as rdered. 186SD5 186SD6 186SD7 186SD8 186SD9 12" 13" 14" 15" 16" 186SD10 186SD11 186SD12 186SD13 17" 18" 19" 20" (E2203 $550.00 2. FRONT SEAT HEIGHT SET UP Frnt Seat Height See FIGURE 8 Measure frm the frnt f the seat rail t the flr. 186SH14 16.0" 186SH20 186SH15 16.5" 186SH21 186SH16 17.0" 186SH23 186SH17 17.5" 186SH24 186SH18 18.0" 186SH26 186SH27 Figure 8 18.5" 19.0" 19.5" 20.0" 20.5" 21.0" 186CW1 186CW3 186CW31 186CW72 186CW44 186CW64 186CW5 186CW51 186CW6 186CW65 186CW7 186CW66 186CW34 186CW33 Caster Wheels 3" Micr 4" Lw Prfile Plyurethane 4" Micr Lighted 4" x 1" Aluminum Ply 4" x 1.25 Semi Pneumatic 4" x 1.5" Aluminum Sft Rll 5" Lw Prfile Plyurethane 5" Micr Lighted 5" Sft Rll (Grey -NA w/frg Legs 5" x 1" Aluminum Ply 5" x 1.5" Semi Pneumatic 5" x 1.5" Aluminum Sft Rll 6" Ply $70.00 $100.00 $55.00 $175.00 $110.00 $185.00 186CW35 186CW68 E2214 6" Pneumatic E2215 6" x 1.5" Semi Pneumatic 6" x 1.5" Aluminum Sft Rll $195.00 186CF74 186CF65 186CF69 186CF53 186CF54 186CF55 Caster Frks and Suspensin Carbtecture Frks Multiple Psitin Multiple Psitin Single Sided Frk E1015 Frg Legs 0 weight t 100 lbs. E1015 Frg Legs 101 lbs. weight t 190 lbs. E1015 Frg Legs 191 lbs. weight t 265 lbs. $425.00 $425.00 $425.00 Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US LLC. Q7, MK-100021 Rev F Page 2
3. FOOTPLATE OPTIONS Ftrest 186F229 Aluminum Tubular 186F274 Aluminum Tubular w/ Snap On Cver 186F276 K0040 Angle Adjustable Flip Back 186F51 K0040 Platfrm Ftrest 186F111 Ultra Lite Platfrm Ftrest NA w/ 14" wide and 2" inset, NA w/ 19-20 wide w/ 0" inset Adaptive Platfrm Spacer NA with Aluminum Tubular r Ultra Lite Platfrm. Nw available with Angle Adj. Flip Back. 186AD1 186AD2 186AD3 K0040 Adaptive Platfrm 2" Spacer Adaptive Platfrm 4" Spacer Adaptive Platfrm 6" Spacer $30.00 $185.00 $115.00 186DI08 186DI03 186DI04 186DI05 186DI07 186DI02 186DI06 K0037 K0038 K0038 Ftrest Optins High Munt Ext Tubes (NA w/ Tubular ftrest $55.00 Leg Strap $35.00 Extra Leg Strap $35.00 Gel Hanger Cver $105.00 Neprene Impact Guards Wear Pads $50.00 Psitin Plates (NA fr Tubular Ftrest $50.00 4. BACKREST 186BT96 Flding Angle Adj w/duble Lck Dwn Back Type 186BT3 Nn-Flding Angle Adjustable 186B110 186B110 186B110 186B110 Chse Optin 1 r 2 1. Aluminum Height Adjustable Backrest 2. Ultra Lightweight Aluminum Fixed Backrest 10 "- 14" Back Height Select back height. 8", 9", r 10" nly available with mit push handles. 10 11 12 13 14 17", 18", r 19" nly available with fld dwn push handles 12 "- 16" Back Height 186BB21 8" 186BB17 14" 12 13 14 15 16 186BB20 9" 186BB18 15" 14 "- 18" Back Height 186BB13 10" 186BB19 16" 14 15 16 17 18 186BB14 11" 186BB10 17" 16 "- 20" Back Height 186BB15 12" 186BB11 18" 16 17 18 19 20 186BB16 13" 186BB12 19" Twel Bar Military Service Patches 186QT01 Standard Style - 4" Offset Only available n tensin adjustable uphlstery and Jay 3 Back Lw Prfile - 2" Offset Limited 186VU1 US Marines Patch $90.00 186QT02 w/slid Backs, Nt suggested with $50.00 186VU2 US Army Patch $90.00 19" & 20" wide 186VU3 US Navy Patch $90.00 186VU4 US Air Frce Patch $90.00 Backrest Handles 186VU12 Cast Guard Patch $90.00 186PH6 Integral Push Handles 186VU5 Purple Heart Patch $90.00 Fld Dwn Push Handles NA w/ 10"- 186VU8 Purple Heart with Marines Patch 186PH5 14" adj height & 8"-10" fixed height $100.00 186VU9 Purple Heart with Army Patch NA w/ standard uphlstery 186VU10 Purple Heart with Navy Patch 186PH2 Omit Push Handles 186VU11 186VU13 Purple Heart with Air Frce Patch Purple Heart with Cast Guard Patch Backrest Uphlstery 186BU1 Standard Uphlstery Backrest Optins 186BU70 E2611 Backrest Tensin Adj Ballistic Nyln $315.00 Telescping Push Handlles have Duble "D" tubing t eliminate rtatin. 186BU71 E2611 Backrest Tensin Adj 3DX Vented $330.00 Narrw Backrest Inset Backcanes 1" 186BU14 Omit Back Uphlstery -$15.00 narrwer than selected seat width. NA with 186OD5 12" Wide. NA w/ Aluminum r Carbn Side $80.00 JAY J3 Back Guards 186JB01 Telescping Push Handles Range f J3 Back T rder a J3 Back please 186A192 $215.00 13-19" frm sling t handle select Omit Back Uphlstery. See J3 Back Price List Order Frm fr Part #'s. Telescping Push Handles - Tall 186A195 $215.00 (25" frm seat t push handle Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US LLC. Q7, MK-100021 Rev F Page 3
Axle Plate Extended COG NA w/ Xtender Pwer Assist Adjustable COG (1"-4" Adjustable Extended COG (0"-3" 4-Link Rear Suspensin COG (0"-3" Single Pst nly available up t 2" COG. Plastic Side Guards nly available up t 2.5" COG. NA w/ Xtender 186SV08 186SV09 Weight frm 0 lbs t 175 lbs Weight frm 176 lbs. t 265 lbs $595.00 $595.00 Rear seat height is 16.5" t 20", 0 camber, ships with 1" COG, pneumatic tire. 24" wheels nly. Anti-Tips n charge. NA w/ Padded Swing Arms r Transit. 186XT3 E0986 Xtender Pwer Assist 4X Multiplier LITHIUM Please select ne f the fllwing handrim ptins 186XH3 186XH4 Plastic Cated Stainless Steel 186XT2 186XA1 186XA7 186XA2 186XA4 E0986 E2213 Rear Suspensin (Optinal Xtender Pwer Assist Xtender Pwer Assist 4X Multiplier NICKEL Xtender - Other Optins Spare NiMH Pwer Pack - NICKEL Spare NiMH Pwer Pack - LITHIUM Xtender Wheel Optins SPARE 24" Lite Spke Pneu Alum 5. REAR SEAT HEIGHT SET UP $6,595.00 $7,595.00 $1,395.00 $1,795.00 SPARE 24" Lite Spke Pneu Plastic $90.00 Axle Center f Gravity Preset 186AX1 Quick Release Steel Measure frm frnt f back pst t the center f rear axle. Quad Quick Release Steel 186AX13 186CC12 0" Only available with Std Mag Whls 186CC1 186CC2 186CC3 186CC4.5" 1.0" 1.5" 2.0" Rear Wheel Ultra Lightweight nly available w/ Aluminum Handrim. Cntact Built 4 Me fr Spinergy clr ptins r Tplin Carbn Wheels. 186CC5 2.5" 186RW3 20" Mag 186CC6 3.0" 186RW8 22" Mag 186CC7 3.5" 186RW1 24" Mag 186CC8 4.0" 186RW103 20" Mag Wheel 5 Spke 186RW104 22" Mag Wheel 5 Spke Camber 186RW102 24" Mag Wheel 5 Spke 186CI1 0 186RW90 20" Lite Spke $200.00 186CI2 3 186RW91 22" Lite Spke $200.00 186CI4 6º (N/A with Std Mag and 5 spk MAG 186RW92 24" Lite Spke Wheels 186RW93 25" Lite Spke 186RW94 26" Lite Spke $80.00 Wheel 5 Spke Ultra 186RW06 22" Ultra Lightweight Spke 2.0 Mag Lite Spke Spinergy Tire Mag Lt wt 186RW10 24" Ultra Lightweight Spke 2.0 Full Ply Tire 20,22,24 20,22,24 20,22,24 186RW16 25" Ultra Lightweight Spke 2.0 High Press. Clincher 22,24,25,26 22,24,25 22,24,25,26 186RW28 22" Spinergy SPOX Black Spkes $795.00 SHOX Perfrm. Ply 20,22,24 24 24,25 24,25 186RW95 24" Spinergy SPOX Black Spkes $795.00 Knbby V-TRAK 24 24 186RW96 25" Spinergy SPOX Black Spkes $795.00 Pneumatic 20,22,24 20,22,24 20,22,24,26 22,24,26 186RW97 26" Spinergy SPOX Black Spkes $795.00 Pneumatic 186RW32 22" Spinergy LX Black Spkes $995.00 w/airless Insert 20,22,24 20,22,24 20,22,24,26 22,24,26 186RW98 24" Spinergy LX Black Spkes $995.00 Schwalbe Marathn Schwalbe Speed Run 24,25,26 24,25 22,24,25 24,25 24,25,26 24,25 186RW99 186RW40 25" Spinergy LX Black Spkes 26" Spinergy LX Black Spkes $995.00 $995.00 22" = 489 mm 24" = 540 mm 25" = 559 26" = 590 186RW50 24" Muntain 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. 186RH11 186RH12 186RH13 186RH14 186RH15 186RH16 186RH17 186RH18 186RH19 186RH26 186RH20 186RH27 186RH21 186RH37 186RH22 Rear Seat Height 13.0" Only w/ 20" Rear Wheel. NA w/ Rear Suspensin 13.5" Only w/ 20" Rear Wheel. NA w/ Rear Suspensin 14.0" Only w/ 20" Rear Wheel. 14.5" Only w/ 20" Rear Wheel. 15.0" Only w/ 20" r 22" Rear Wheel fr Adjustable Axle. Only w/ 20" Rear Wheel fr Rear Suspensin 15.5" Only w/ 20" r 22" r 24" w/hp Clincher Rear Wheel. Only w/ 20" Rear Wheel fr Rear Suspensin 16.0" NA w/ 24, 25 & 26" Rear Wheels and Rear Suspensin 16.5" NA w/ 24, 25 & 26" Rear Wheels and Rear Suspensin 17.0" 17.5" 18.0" 18.5" 19.0" 19.5" 20.0" NA w/ Rear Suspensin Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US LLC. Q7, MK-100021 Rev F Page 4
Rear Wheel Tire Handrim 186RT3 E2218 Full Ply Tire Natural Fit Handrims nly available in 22", 24", & 25". 186RT6 Natural Fit w/ 5 spke MAG nly available in 24" High-Pressure Clincher 186HR1 Aluminum Andized 186RT38 E2218 SHOX Perfrmance Ply Plastic Cated NA w/ 25" & 26" 186HR4 Lite Spke Wheels 186RT27 Knbby V-TRAK by Kenda 186HR22 Natural Fit - Standard Grip $375.00 186HR23 Natural Fit - Super Grip $410.00 186RT12 Muntain Only available in 24" 186HR30 Natural Fit LT - Standard Grip $375.00 186HR31 Natural Fit LT - Super Grip $410.00 186RT1 Pneumatic Spinergy Flex Rim Only available n 186HR24 $525.00 Spinergy LX wheels 24" & 25" 186RT2 Pneumatic Airless Insert $80.00 E2213 Omit Handrim 186HR7 NA w/ Ultra Lightweight Wheels 186RT21 Schwalbe Marathn Plus Evlutin 186RT28 Schwalbe Speed Run Tire 5. REAR SEAT HEIGHT SET UP (CONT 5. ARMREST Armrest - Padded Swing Away Armpad - Fr Height Adjustable Sme limitatins when used with the Angle Adjustable Back in the rear mst setting 186AM23 Desk Length (10" Classic Please select a setting, will default t 11" if n selectin is made 186AM21 Desk Length (10" Cntur 186AA18 E0973 Padded Swing-Away STD (9" t 14" $210.00 186AM24 Full Length (14" Classic 9" 10" 11" 12" 13" 14" 186AM22 Full Length (14" Cntur 186AA11 E0973 186AA29 E0973 Armrest - Height Adjustable Single Pst Height Adjustable - Std Range 8" - 13". Adjust in 1" increments Single Pst Height Adjustable - Lw Range 6.5" - 10.5". Adjust in 1" increments $285.00 $285.00 186NP01 Armrest Optins Gel Swing Away Pad $105.00 6. KEY OPTIONS & ACCESSORIES 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 186WL12 Wheel Lck Optins D Nt Munt Side Guard - Clr Optin Available with Aluminum r Aluminum with Fender. 186GE01 Black 186GE02 Matching Frame- Standard Clrs 186GE03 Matching Frame- Custm Clr $50.00 Psitining Belt 186A117 E0978 Belt 2" Aircraft Buckle w/clamps $110.00 186A118 E0978 Belt 2" Aircraft Buckle Padded w/clamps $120.00 186A141 E0978 Belt 1.5" Aut Buckle Universal w/clamps $70.00 Extensin Handle Ext. handles nly available with high munt push r pull wheel lcks 186EH7 E0961 Extensin Handle (Pair 186AT37 E0971 Anti Tips Anti Tips (Pair Side Guards Increases verall width f chair. Sme interferance may exist w/ padded SA arms at lwest settings 186SG33 K0108 Plastic Standard NA w/ Height Adjustable Arms 186SG29 K0108 Plastic Lw NA w/ Ht Adj Arms Aluminum NA w/height Adj. Arms, High 186SG35 K0108 Push r Pull Wheel Lcks $235.00 186SG36 186SG12 K0108 K0108 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 $65.00 $140.00 $245.00 $450.00 Spke Guards Nt available with 5 spke MAG wheels 186A23 K0065 Black Spke Guard 186A302 K0065 Quickie "Q" Clear 186A1 186A2 186A8 186A203 186A83 E2207 Additinal Pack Accessries Backpack - Adult $55.00 Backpack - Kids $50.00 Black Seat Puch $45.00 Miscellaneus Crutch Hlder Tl Kit $115.00 $115.00 $195.00 $45.00 Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US LLC. Q7, MK-100021 Rev F Page 5
6. KEY OPTIONS & ACCESSORIES (CONT Frame Clr 186C118 Bead Blast 186C140 Aztec Gld 186C2 Black (Nt avail as base w/zebra 186C141 Black Cherry 186C10 Black Opal 186C38 Blue Opal 186C36 Candy Blue 186C14 Candy Purple 186C35 186C142 Candy Red Electric Blue 186C143 Evergreen 186C126 Glw 186C144 Green Apple 186C147 Ht Sparkle Pink 186C148 Mauve Pink 186C103 Rtbeer 186C114 Sparkle Silver 186C145 Sunrise Orange 186C113 Titanium Clr Paint 186C8 Yellw 186C44 Glssy White - Limited Editin 186C112 186C43 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 and Carbtecture frks. Andized parts can be rdered separately 186EB07 Black 186EB08 Blue 186EB09 Green 186EB10 Purple 186EB11 Red 186EB12 Ti Grey Built Fr Me T inquire abut any unique custmizatin fr Quickie prducts, cntact: Phne: (800 333-4000, Optin #3, Fax: (800 333 9011 Matte Frame Clrs 186C116 Matte Black 186C151 Matte Black Cherry 186C150 Matte Electric Blue 186C149 Matte Evergreen 186C152 Matte Purple Cmmnly Requested Optins Include: Swing Away Knee Adductrs One Arm Drive Unilateral Wheel Lcks Seat Pan Caster Pin Lck Grade Aids Spinergy Clr Spkes Duble D Telescping Push Handles Custmer Service: 800-333-4000 Fax: 800-300-7502 Email: rders@sunmed.cm www.sunrisemedical.cm Specificatins are subject t change withut ntice. Cpyright 2011 Sunrise Medical (US LLC. Q7, MK-100021 Rev F Page 6