ross 5 Prescription form 7586J 07-05-08 Reference: Name: Tel: ate: Standard version is marked with The measurements given can vary ±% Short frame Seat width (cm) Seat depth 36-4 (-49*)cm Measured from back post (*Triangular back support) Long frame Seat width (cm) Seat depth 4-48 (-55*)cm Measured from back post (*Triangular back support) 35 3300 4,5 33007 50 3303 37,5 33003 45 33009 40 33005 47,5 330 35 3300 4,5 33008 50 3304 37,5 33004 45 3300 40 33006 47,5 330 Side frame ctive (Only in colour -0) rame colour ack support ross back 3 lack -0 Silk grey -94 oral -96 Yellow -99 ark blue -93 Moss green -95 Type Lumbar angle Standard +7 Triangular -8 - +8 Heather purple -97 ack support height Standard 3-45 cm (std 40 cm) Indicate height cm Lumbar angle ack support height High 38-5 cm (std 46 cm) Indicate height cm ack support angle -5 - +0 (std + ) Indicate angle ack support angle over Standard omfort Tidy ack support ross back ack support ross back, widened ontinuosly adjustable 30-45 cm. Standard 35 cm ontinuosly adjustable 30-45 cm. Standard 35 cm xtends the width 5 cm Indicate height: cm Indicate height: cm over standard over comfort ack support tubes for hard shell back support, S ack support tubes for hard shell widened back support, S ack support angle -5 - +5 Push handles Push handles etachable, height adjustable ontinuosly adjustable 30-45 cm Standard 35 cm ontinuosly adjustable 37-4 cm Standard 37 cm xtends the back support width by 5 cm Standard + = 9 between back and seat ow handle etachable, height adjustable (for seat and back support system S, see separate prescription form at www.etac.com) Indicate angle Push handles fixed for ross back 3 (seat width 35-50 cm)
tac / ross 5 / www.etac.com ixed back support with fixed push handles ixed upholstery ack support angle adjustable -5 - +5. Standard + = 9 between back and seat djustable upholstery Indicate angle ack support height settings 37,5 cm 40 cm 4,5 cm 45 cm Seat Seat upholstery djustable seat depth, 6 cm Solid seat, detachable ixed seat upholstery (only with ixed back support and fixed back support upholstery) With angled brake handle With extension arm, foldable Single-hand brake Ri Ri Ri rakes Le Le Le Red lack With angled brake handle rum brakes Standard (not for bow handle) With larger grip Leg supports lack etachable/swing away with locking device Standard Narrow Short/Narrow Ri Ri Ri Le Le Le Yes Yes Yes No No No levating leg supports Mod without calf support Mod 3 without calf support Mod with calf support foldable, adjustable in angle, depth and sideways Mod 3 with calf support foldable sideways in two height positions. rom 40 cm seat width (with two leg supports) Ri Ri Ri Ri Le Le Le Le Options for Mod and Mod 3 without calf support ttachment for calf support Ri Le ttachment for calfsupport, foldable Ri Le alf support Ri Le oot supports lip-up, adjustable in depth, angle and height. Tube, standard length Tube, short length (-8 cm) only for short/narrow leg support Tube, long length (+0 cm) ootrest one piece lip-up, adjustable in angle. Leg supports Others mputee support adjustable in height, angle, depth and sideways mputee weight an be combined with amputee support ootrest one piece compl. 35/37,5 djustable in height, depth and angle. etachable Plaster leg support With fixed 0 degree knee angle. Support plates are adjustable Ri Ri Ri Ri Le Le Le Le Material Plush rey hygiene
tac / ross 5 / www.etac.com 0 4 arbon 4 (not with drum Pneumatic high pressure Pneumatic high pressure Pneumatic high pressure Pneumatic high pressure Rear wheels with quick release Pneumatic 3/8 (not with drum Pneumatic 3/8 (not with drum Pneumatic 3/8 (not with drum Pneumatic 3/8 (not with drum Solid Solid Solid Solid 6 Pneumatic high pressure Pneumatic 3/8 (not with drum Solid 0 4 arbon 4 (not with drum luminium luminium luminium luminium Stainless steel Stainless steel Stainless steel Stainless steel ellular rubber ellular rubber ellular rubber ellular rubber Vinyl coated (not with solid tyre) Vinyl coated Vinyl coated Vinyl coated Handrims 6 luminium Stainless steel ellular rubber Vinyl coated Single hand-drive (not with drum 0 Handrims on Right 4 Left 4 (00x30 mm) solid 7 (75x45 mm) semipneumatic astors 5 (5x30 mm) solid 8 (00x35 mm) semipneumatic 6 (50x30 mm) solid 8 (00x50 mm) semipneumatic 6,5 (65x30 mm) solid 8 (00x30 mm) pneumatic ront fork attachment Standard Low widened (for 4 castors) Widened (moves castor 3 cm to the side for foot propulsion) amber angle 0 Rear wheel 0 4 6 Pos 46 48,5 5 53 44 46,5 49 5 Rear seat height (cm) 4 44,5 47 49 40 4,5 45 47 38 40,5 43 45 36 38,5 4 43 34 36,5 39-3
tac / ross 5 / www.etac.com astor Indicate height Position xtra short front fork 4 (00 kg user weight) 34-39,5 cm cm 5 36-44,5 cm cm Short front fork 6 40-45,5 cm cm 6,5 4-46,5 cm cm ront seat height (cm) 3 3 Medium front fork 5 43-49 cm cm 6 45-50 cm cm 6,5 46-5 cm cm 8 48-5 cm cm 8 x (00x50 mm) 46,5-50,5 cm 8 x (pneumatic) 46,5-50,5 cm Long front fork 6,5 50,5-55,5 cm cm 8 5,5-56,5 cm cm 0 amber angle alance position or seat height/seat angles, see front/rear seat height above. 3 4 5 6 3 4 5 6 3 5 Indicate balance position -6 (standard pos 4) ccessories ross rm support rm support rm support rm support With detatchable arm support plate, length 5 cm, height adjustable djustable with fingerscrew Massive moulded plate, length 5 cm, height adjustable djustable with fingerscrew With detatchable arm support plate, length 35 cm, height adjustable djustable with fingerscrew Massive moulded plate, length 38 cm, height adjustable djustable with fingerscrew right 730- left 730- right 7349- left 7349- right 57- left 57- right 6379- left 6379- right 73- left 73- right 7350- left 7350- right 573- left 573- right 6380- left 6380- over arm support its arm support with massive moulded plate ark grey plush, detachable, length 5 or 38 cm Padded 5 cm Quantity pcs 68-60 Padded 38 cm Quantity pcs 683-60 el 5 cm Quantity pcs 640-60 el 38 cm Quantity pcs 64-60 4
rm support Hemi etachable cover, dark grey plush, sideways angle adjustable its with long arm supports 73-/ and 7350-/ etachable cover, dark grey plush, sideways angle adjustable its with long arm supports 573-/ and 6380-/ tac / ross 5 / www.etac.com right 733-60- left 733-60- right 5770-60- left 5770-60- rm support pad wide and soft its arm support with massive moulded plate 8x40 cm, to be mounted on arm supports pcs 6873 Side support Thigh support Soft pad lack, adjustable in height To be mounted on short or long arm supports, front attachment is included. Limitations: 4 wheel, not in -, -, -, -, -, - wheel, not in -, -, -, -, 0 wheel, not in -, -, or thigh support, velcro attachment right 589- left 589- Short right 739- Short left 739- Long right 739- Long left 739- right 8488- left 8488- Mudguard arbon fibre, adjustable in height and depth to fit rear wheel position right 7397- left 7397- Width expansion kit xtends rear wheels, brakes and arm supports 5 mm on each side (not together with drum 7533 Tray To be mounted on long arm supports, transparent Seat width cm 35 447 37,5 587 40 448 4,5 588 45 449 47,5 573 50 460 5,5 600 55 60 Tray Hemi Non-slip cover for Tray Hemi Incl. cover with velcro lock or table as above Seat width rm support short Seat width rm support long 35 cm 6556 35 cm 6563 37,5 cm 6557 37,5 cm 6564 40 cm 6558 40 cm 6565 4,5 cm 6559 4,5 cm 6566 45 cm 6560 45 cm 6567 47,5 cm 656 47,5 cm 6568 50 cm 656 50 cm 6569 35-40 cm Quantity pcs 8633 4,5-50 cm Quantity pcs 8634 Tray Hemi/ ommunication Seat extension ross back 3 oldable, adjustable in depth and width. Transparent xtends the seat depth up to 7 cm at rear, in combination with triangular back support right 735- left 735- Seat width 35-4,5 cm 6976 Seat width 45-60 cm 6977 5
tac / ross 5 / www.etac.com Seat cushion omfort wedge Seat cushion Tidy ark grey plush, 56 cm long, anatomically shaped, cut to individual seat depth Increases the contour. To be placed in the pocket of the inner front upholstery wipeable Seat width cm 35 630-60 37,5 63-60 40 63-60 4,5 633-60 45 634-60 47,5 6374-60 50 666-60 5,5 640-60 55 64-60 Seat width cm 35-37,5 8074 40-45 8075 47,5-50 80779 Seat width cm 35 63098-63 37,5 63099-63 40 6300-63 4,5 630-63 45 630-63 47,5 6303-63 50 6304-63 5,5 6305-63 55 6306-63 57,5/60 6307-63 S seat- and back support alf support cover alf strap Padding for calf strap The seat- and back support system offers products and covers in different kinds of upholstery and fabrics (see separate prescription form at www.etac.com) ark grey plush or elevating leg support model 3 lack artex or elevating leg support model 3 etachable, adjustable in length Quantity pcs 676-60 Quantity pcs 676-63 Seat width cm 35-37,5 5356 40-4,5 5357 45-47,5 5358 50-5,5 5359 50 606 0 cm 6845 30 cm 6846 40 cm 6847 oot support extension Heel strap Mounted on foot support djustable in length Seat width cm 40-4,5 Quantity pcs 50798 45-47,5 Quantity pcs 50799 50-55 Quantity pcs 50800 right 4458 left 4458 Positioning belt Two-part with snap-lock. alt. attachment points on wheelchair frame Quantity pcs 5668 Head support urved, padded. djustable in height, depth, angle and sideways. grey hygiene 83-65 dark grey plush 83-60 6
Head support incl. height adjustable tube 45 attachment, to be mounted on bow handle tac / ross 5 / www.etac.com 405766 40576 405767 With side support, plush, padded urved 50x40 mm With sideways adjustability Height adjustable tube Head support 40655 40060 4006 45 attachment 90 attachment urved 35 85 47,5 830 37,5 86 50 83 Head support attachment or ross back 3, mod 4 40 87 5,5 83 4,5 88 55 833 45 89 Head support bracket or bow handle 5795 35 84 47,5 89 37,5 85 50 80 ack support brace or ross back 3, mod 4 40 86 5,5 8 4,5 87 55 8 45 88 35 743 47,5 564 37,5 560 50 5739 ack support brace oldable with snap-lock Seat width cm 40 56 5,5 565 4,5 56 55 6030 45 563 ack support wedges Polyethylene foam, three different sizes. an be cut to desired shape H:, W:9, L:3 cm 8030 H:, W:, L:8.5 cm 839 H:.5, W:7.5, L:0 cm 840 ack support wedge ark grey plush Short 5 cm Quantity pcs 630-60 Long 30 cm Quantity pcs 6303-60 Side cushion Provides gentle lateral support. Used when the trunk support is too stabilising. (ombined with arm support and, if necessary, side stop) Right 637-60- Left 637-60- Side stop Trunk support Straight or angled. ombined with wedge or side support cushion. reates a more distinct stop and holds the wedge or side support cushion in place. djustable, swing-away and detachable Straight pcs 836 Widening 5 mm pcs 837 Widening 30 mm pcs 873 0 Right 84-0 Left 84- -5 Right 880- -5 Left 880- -45 Right 88- -45 Left 88-7
tac / ross 5 / www.etac.com Trunk support Settable and detachable 0 pcs 84 +5 pcs 843-5 pcs 844-45 pcs 845 Trunk support artex, fixed, adjustable in height, depth and width Quantity pcs 7395 PUR, fixed, adjustable in height, depth and width Quantity pcs 797 Trunk support PUR, swing away, adjustable in height and depth Medium Right 795- Medium Left 795- Large Right 796- Large Left 796- nti-tip Telescoping, flip-up (not with side frame ctive) 756 Settable in height and length, flip-up 577 Settable in length, flip-up. 5633-0 nti-tip for side frame ctive Limitations: nti-tip for ross 5 ctive not with rear wheels in following positions. 0 rear wheel rear wheel 4 rear wheel 6 rear wheel 3 4 5 6 3 4 5 6 3 4 5 6 3 4 5 6 33 4 55 6 3 34 5 56 3 34 5 56 ane holder Universal right 737 left 737 rey with logo Yellow with logo Spoke guard Other spoke guards see www.etac.com 0 550-8 0 550-9 5503-8 5503-9 4 5504-8 4 5504-9 Tetra quick release adapter Quantity pcs 405-0 Locking strap or a folded wheelchair 75 Toolkit 574 or sizes see www.etac.com 9009 loves Item no ags ellular phone holder 900 tac ox 03, 334 4 nderstorp Sweden Tel +46 37 58 73 00 ax +46 37 58 73 90 www.etac.com 8