R82 Flamingo Flamingo High-Low

Similar documents
R82 Kudu - E1233. CAD Retail Price List/ Order Form. Account #: Purchase Order No.: Kudu Standard Features:

R82 Kudu - E1233. Retail Price List/ Order Form. Account #: Purchase Order No.: Kudu Standard Features: Recline No HCPCS Code Assigned to Kudu sz 4

R82 Kudu - E1233. Retail Price List/ Order Form. Account #: Purchase Order No.: Kudu Standard Features: Recline No HCPCS Code Assigned to Kudu sz 4

R82 Wombat Living. CAD Retail Price List/ Order Form. Account #: Purchase Order No.: Date: Wombat Living Standard Features:

R82 Caribou - E0641. Retail Price List/ Order Form. Account #: Purchase Order No.: Date: Caribou Standard Features:

R82 Stingray - E1233

R82 x:panda. USD Retail Price List/ Order Form. Account #: Purchase Order No.:

R82 x:panda. USD Retail Price List/ Order Form. Account #: Purchase Order No.:

R82 Caribou - E0641. USD Retail Price List/ Order Form. Account #: Purchase Order No.:

R82 Stingray. CAD Retail Price List/ Order Form. Account #: Purchase Order No.: City/State/Zip: Effective: 2/01/ Rev 7.

Convaid Trekker 2 - HCPCS E1234 Retail Price List / Order Form

Convaid Trekker 2 - HCPCS E1234 Canadian Retail Price List / Order Form

x:panda, size 1, med. back X c x:panda, size 1, med. seat 7¼" X c

Page 1/133. Price and ordering list. Mustang B (Shoulder height)

Phone: Nov-17

R82 Rabbit Up - E0638 / E0642 USD Retail Price List/ Order Form

Canadian Suggested Retail Price List April 2015

Shower commode chairs. Ocean. Series

Shower commode chairs

Phone: Jan 17. Fax: usa.com Quote: P.O. usa.com Bill To

Invacare REA Azalea Transit RETAIL Max User Weight 135Kg (21 stone)

SB1 ShowerBuddy. Dignity Ease Comfort

Amfibi. Hygiene chair

Aquatec Ocean Family. Ocean Family. Aquatec

Aquatec. Ocean Family. Flexible, modular shower chair commode solutions

Accessories brochure

Traxx 3 & Atigra 2 Script Form

This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. AADL CAT # 151.

Etac Prio. A comfort wheelchair with unique innovations.

Adjustable Height Raised Toilet Seat Model 101 RTS Pricelist/Order Form December 2014

WHEELCHAIR RANGE. aspire for... Comfort Posture Mobility DANISH DESIGN

Technical Manual. Thevo The perception seat for dynamic seating. Models. Accessories ThevoTwist. Accessories A chassis

EASyS Modular. Technical Manual. EASyS Modular Rehab stroller. Models. Accessories for EASyS Modular seat unit. Accessories for A and Q chassis

Basic price 2.250,- Excl. VAT

INVACARE CANADA. Shower Commodes

BENTLEY. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.

Adult Manual Wheelchairs. Etac Cross 5 Active. Creating stability for activity

Mygo Seat Spare Parts Catalogue

STELLAR. 15" Seat Width 18" Seat Width. Requires Heavy Duty Base and Seat Frame. Extended delivery lead times may apply.

BENTLEY. Order Form - AADL - W322 Prices in Canadian Dollars. October 1, W h e e l L o c k s. A n t i - T i p p e r s. B a c k P o s t S t y l e

Standard Base Price: 618

TILT COMMODE September 16, 2011

MASS Script Form. 160 Kg Weight Capacity Charge. Transit Option. 136 Kg maximum weight capacity. Not available with Removable Seat Pan.

INVACARE CANADA AQUATEC Shower Commodes

Start M2S. Lightweight wheelchair. Unit price: EUR X,XXX (side panels and footrests included) Provide estimate only Order. Standard equipment

BINGO Evolution rehab pushchair

q q q q q q q q q q q q q q q q q q Frame q Titanium Frame K5-CAT5-TITAN $ Includes hangers and base frame. Does not include Cross Braces.

Manufacturer: Model: Seat width: cm Seat depth: cm

Positioning Components Order Form - ODJFS Only

2016 EZ RIDER UPRIGHT PRODUCT PPT

Dealer Please check the correct box according to the measured hip width in a sitting position: 35 cm 48 cm

Nielsen Line. Shower/Commode. HMN a/s

discovery tmax Base price: EUR x,xxx q Provide estimate only q Order q Order no.: Attachment for custom fabrication enclosed

Note Section. Set-to-Spec. This section must be filled out, otherwise the selection will default to the mid-range measurements.

Synthesis Tilt Recliner Model: V4

Velocity Order Form. Dealer Information Dealer Name ATP Account Number Phone Fax Date PO# Ship to Address City State Zip

Please make your selection with a cross in the box Standard feature Free of Charge

Height adjustable footplates, equipped with nylon heel loops. Standard with maintenance free PU front (7 ) and rear wheels (24 ).

Black -01 Moss green -95 Yellow -99. Heather purple -97. Indicate height. Indicate height. Indicate angle. Indicate height: cm. Indicate height: cm

SHIPPING INFORMATION. Order

STELLAR GL. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

Please check the correct box according to the measured hip width in a sitting position: 35 cm 48 cm

NEW. Combined toiletand shower chair

STELLAR. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

Invacare Storm4 Easy Adapt Retail Max User Weight 150kgs (23.5 stone) Standard Features

The HTS HTS ( HYGIENE & TOILETING SYSTEM)

Invacare EXPRESS Manual Wheelchair Order Form Suggested Canadian Price List Effective October 30th, 2018

Customer code C- Invoice address. Max. 90 kg See page 5 Side upholstery (reduces SW with 2 x 2 cm) = Standard equipment

Frame Width. Seating Setup. q 16 q 15 q 14 q 17 q 16 q 15 q 14 Short q 18 q 17 q 16 q 15 q 14 q 19 q 18 q 17 q 16 q 15 q 14

FUZE T20. Order Form - Canada Prices in Canadian Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

Technical Manual. Swifty The rehabilitation buggy. Models Accessories

Invacare Kite (Modulite Flex3 Seating System) Dealer Max User Weight 160Kg (25 stone)

wheelchairs aspire for... mobility comfort style LITE TRANSIT RANGE Aspire EVOKE Aspire EVOKE HD

MODULAR TRAVVLA: ARMREST ONLY (STEM AND TUBE)

Spring Bathroom Safety

FUZE T50. Order Form - USA Prices in U.S. Dollars. January 1, C u s t o m e r a n d O r d e r I n f o r m a t i o n.

PMS 322 C Hygiene chairs

ORDER FORM EIPW25. with CAPTAIN'S SEAT. Print pages 1-10 to exclude pictures. Buyer State Zip

Invacare Action 3 NG Transit Retail Max User Weight 125Kg (19.7 stone)

SHIPPING INFORMATION Provider Acct #: Address: ST: ZIP:

SHIPPING INFORMATION Provider Acct #:

MALTE Posterior Walking Aid

SEATING CHOICE TITANIUM FRONT FRAME

[ ] Quote [ ] Order. Junior US Retail Price List. Account Information. Ship To Information. Standard Features.

FUSION Seating Prescription Form Custom Built Seating System

Spare Parts Catalogue. Version: 2014/10/08b EN

MASS Script Form. Frame. Backrest. Seat Depth

FUZE T50. Order Form USA. Please send your completed order form by to or by fax to

PAGE 2 BREEZY ELEGANCE

Etac Cross 5 and Cross 5 XL

RETAIL Max user weight: 100kg - seat widths 12" & 13" Max user weight: 130kg -seat widths 14" -16"

Invacare Series ContourU Model #'s CM01S, CM01B, CM02S, CM02B

2004 Medicare Billing Guidelines for Rehab Products

Order no.: ... Date Signature. Posterior seat height

Invacare FOX (Modulite Seating System) Retail Max User Weight 127Kg (20 stone)

MASS Script Form. Frame. Backrest. Seat Depth. Tsunami ALX K0005 Charge. Sling Position. Seat Width / Seat Depth. Seat Width.

4.2 HELIO KIDS MODEL. Ultralight Folding Carbon Fiber HELIO KIDS Wheelchair Including angle & depth adjustable back (79 kg lbs weight capacity)

Tilt in space up to 60 degrees Comfort seating Max. user weight: 113kg. Height adjustable folding back Heavy Duty version 158kg

PMS 322 C Hygiene chairs

M1 - NPO. Dealer Information. Client Information. Client Measurements

Transcription:

Account #: Purchase Order No.: Contact: R82 Flamingo Flamingo High-Low Retail Price List/ Order Form Date: Mark For: Bill To: Address: City/State/Zip: Phone: Email Ship To: Address: City/State/Zip: Phone: Flamingo Standard Features: Size 1, 2, 3, 4 Height Adjustable and Foldable Frame 4 White Locking Castors Tilt in Space (+5 to -35 ) Aluminum Frame Reclining Back 100% Waterproof Upholstery for Seat and Back Active Back (No Sides) Upholstery Available in Blue Splash Guard - High Model Flamingo High-Low Standard Features: Size 1, 2, 3, 4 4 White Locking Castors Foot Support Stainless Steel Frame 100% Waterproof Upholstery for Seat and Back Upholstery Available in Blue Height Adjustable Frame Tilt in Space Reclining Back Active Back (No Sides) Splash Guard - High Model Flamingo Seat and Back (A) Flamingo Seat and Back, Blue (A) 1 $550 880101-61 Flamingo Seat and Back, Blue (A) 2 $550 880102-61 Flamingo Seat and Back, Blue (A) 3 $550 880103-61 Flamingo Seat and Back, Blue (A) 4 $600 880104-61 Flamingo Frame (A) Flamingo Frame w/out Footrest (A) 1 $650 880201-NL Flamingo Frame w/out Footrest (A) 2 $650 880202-NL Flamingo Frame w/out Footrest (A) 3 $650 880203-NL Flamingo Frame w/out Footrest (A) 4 $750 880204-NL Flamingo High-Low Bath Frame (A) High-Low Bath Frame w/ Footrest (A) 1 $2,210 880411 High-Low Bath Frame w/ Footrest (A) 2 $2,210 880412 High-Low Bath Frame w/ Footrest (A) 3 $2,210 880413 High-Low Bath Frame w/ Footrest (A) 4 $2,270 880414 Back Option (A) (B) Back Extension (H: 4" x L: 9") (A)* 1, 2 $150 880118-61 Back Extension (H: 4" x L: 9" - 10.2") (A)* 3, 4 $150 880119-61 Mounting Rod for Back Extension 7.9" $46 880120 Back Reinforcement Kit (B) 3, 4 $255 880155 (A)* Requires Mounting Rod for Back Extension Page 1 of 5

Pelvic Positioning (A) (B) Upholstery, Seat w/ Wide Sides, Blue (A)* 2 $105 880166-61 Upholstery, Seat w/ Wide Sides, Blue (A)* 3 $110 880167-61 Upholstery, Seat w/ Wide Sides, Blue (A)* 4 $115 880168-61 Seat Infill for Seat, Blue (B) 1 $55 880185-61 Seat Infill for Seat, Blue (B) 2 $55 880186-61 Seat Infill for Seat, Blue (B) 3 $60 880187-61 Seat Infill for Seat, Blue (B) 4 $60 880188-61 Seat Belt w/ Plastic Lock One Size $30 85100 (A)* Does not include Splashguard. Reduces sz 2 & 3 width by 2", and sz 3 by 3.5" Foot & Leg Positioning (A) (B) Flamingo Foot Support (A) 1 $200 880211 Flamingo Foot Support (A) 2 $200 880212 Flamingo Foot Support (A) 3 $200 880213 Flamingo Foot Support (A) 4 $200 880214 Calf Support (H: 3.9" x L: 41.7") (B) One Size $66 880199 Footrest Straps, Pair $56 85096 Trunk Positioning (A) (B) Bar, Straight, Stainless (A)** 3¾" $0 82569 Bar, Straight, Stainless (A)** 6¼" $0 82648 Cushion, Curved, Each (B)** A: 3¾", B: 7½" $105 6175407 Cushion, Curved, Each (B)** A: 2½", B: 6½" $105 6175408 (C) (D) Cushion, Curved, Each (B)** A: 2½", B: 5¾" $105 6175409 Protection Pads, Each $92 89151 Swing-Away Bracket, Right, Each (C)** A: 1¾", B: 4¾" $225 83300-R (E) (F) Swing-Away Bracket, Left, Each (C)** A: 1¾", B: 4¾" $225 83300-L Swing-Away Bracket, Right, Offset, Each (D) A: 2¼", B: 5" $225 83500-R Swing-Away Bracket, Left, Offset, Each (D) A: 2¼", B: 5" $225 83500-L Sides for Back w/ Upholstery, Blue (E)* 1 $130 880111-61 Sides for Back w/ Upholstery, Blue (E)* 2 $130 880112-61 Sides for Back w/ Upholstery, Blue (E)* 3 $130 880113-61 Sides for Back w/ Upholstery, Blue (E)* 4 $140 880114-61 Vest, Water-Proof Mesh (F) 0 $200 89111-040 Vest, Water-Proof Mesh (F) ¾ $200 89111-07540 Vest, Water-Proof Mesh (F) 1 $200 89111-140 Vest, Water-Proof Mesh (F) 2 $200 89111-240 H-Harness w/ Plastic Lock $60 85105 (A), (B), (C )** Required to complete Swing-Away Lateral Assy (E)* Cannot be combined w/ Swing-Away Lateral Supports (A) (B) Head Support Head Support No. 1, Blue PU (A) $205 6071000 (C) (D) Head Support No. 2, Blue PU (B) $205 6072000 Head Support No. 3, Blue PU (C) $205 6073000 (E) Head Support No. 4, Blue PU (D) $205 6074000 Turtle Bar System, Short (E) 5.1" $230 98619-24 Frame Options (A) Commode Pan w/ Holder for Flamingo (A) 1 $120 880121 Commode Pan w/ Holder for Flamingo (A) 2 $120 880122 Commode Pan w/ Holder for Flamingo High-low (A) 1 $120 880121-HL Commode Pan w/ Holder for Flamingo High-low (A) 2 $120 880122-HL Commode Pan w/ Holder for Flamingo & High-Low (A) 3 $120 880123 Commode Pan w/ Holder for Flamingo & High-Low (A) 4 $120 880124 Page 2 of 5

Frame Options Continued (B) Potty Ring w/ Holders (B)* 1 $130 880121-PR Potty Ring w/ Holders (B)* 2 $130 880122-PR Potty Ring w/ Holders (B)* 3 $130 880123-PR Potty Ring w/ Holders (B)* 4 $130 880124-PR (C) (D) Push Brace (C) One Size $95 880110 Push Handle for Flamingo High-Low (D) 1, 2 $85 880110-HL Push Handle for Flamingo High-Low (D) 3, 4 $85 880110-HLL Single Post Armrest (L: 9"), Set (E) One Size $150 880152 (E) (F) Suction Cups for Seat (F) One Size $135 880150 (B)* Potty ring required for use over the commode (E)* Armrest cannot be used together w/ Sides for Back - 88011X-X Accessories (A) (B) Swing-Away Armrest/Tray, Blue (A) 1 $200 880131-61 Swing-Away Armrest/Tray, Blue (A) 2 $200 880132-61 Swing-Away Armrest/Tray, Blue (A) 3 $200 880133-61 Swing-Away Armrest/Tray, Blue (A) 4 $200 880134-61 Splashguard, Low Model, Blue (B) 1 $38 880195-61 Splashguard, Low Model, Blue (B) 2, 3, 4 $38 880196-61 IMPORTANT: No returns or exchanges of hygiene products For shipping rates, please call 1-844-876-6245 PO Box 1739 Matthews, NC 28106 1-844-876-6245 Fax: 704-882-0751 Prices in USD & is subject to change w/out notice www.r82.com Effective: 10/9/2017 Rev 4 Page 3 of 5

Flamingo Configuration Flamingo/Flamingo High-low Head support Push handle/push brace Side supports Arm rest/tray Commode pan/potty ring Vests and belts A (Back height) B (Arm height) C (Lower leg length) D (Seat depth) E (Chest width) F (Seat width) G (Height from seat to top of head) H (Shoulder width) Age Weight Measurements Size 1 Size 2 Size 3 Size 4 Inches Inches Inches Inches Seat width (A) 9¼" 11" 12½" 13¼" Seat depth (B) 9¾" 11¼" 13¾" 15½" Back height (C) 13¾" 14¾" 16½" 18¼" Lower leg length (D) 18" - 26" 25" - 35" 30" - 40" 30" - 40" - 7" - 10" 9¾ - 13½" 11¾" - 15½" 11¾" - 15½" Seat height (E) 50" - 60" 50" - 60" 50" - 60" 50" - 60" - 19½" - 23½" 19½" - 23½" 19½" - 23½" 19½ - 23½" Back width (F) 7¾" 8½" 10¼" 11½" Width, frame (G) 17" 18" 19¼" 21" Length, frame (H) 26" 26" 26" 26" Height, frame w/seat (I) 33½" 35" 36½" 37" Seat height, folded 9½" 10" 10½" 10½" Seat length, folded 14½" 15½" 17" 18½" Frame height, folded 8" 8" 8" 8" Frame length, folded 29" 29" 29P 29" Weight 24 lbs. 29 lbs. 31 lbs. 33 lbs. Max. Load/user weight 77 lbs. 110 lbs. 132 lbs. 154 lbs. Angling Seat -15 -+35 Back -90-30 Foot support bar 90-60 Page 4 of 5

Flamingo High-Low Configuration Flamingo/Flamingo High-low Head support Push handle/push brace Side supports Arm rest/tray Commode pan/potty ring Vests and belts A (Back height) B (Arm height) C (Lower leg length) D (Seat depth) E (Chest width) F (Seat width) G (Height from seat to top of head) H (Shoulder width) Age Weight Measurements Size 1 Size 2 Size 3 Size 4 Inches Inches Inches Inches Seat width (A) 9¼" 11" 12½" 13¼: Seat depth (B) 9¾" 11¼" 13¾" 15½" Back height (C) 13¾" 14¾" 16½" 18¼" Lower leg length (D) 7¼" - 9¾" 9" - 13¼" 11¾" - 16½" 11¾" - 16½" Seat height above floor (E) 20¾ - 28¾" 20¾" - 28¾" 20¾" - 28¾" 20¾" - 28¾" Back width (F) 7¼" 8½" 10¼" 11" Frame width (G) 19½" 19½" 22¼" 22¼" Frame length (H) 25" 25" 29½" 29½" Total height (I) 33½" - 42" 35¾" - 43¼" 36¾" - 45¾" 39¾" - 46¾" Seat, total width 13¾" 14¾" 16¾" 18¾" Seat, total depth 10¼" 12¼" 14" 16½" Seat, total height 15½" 16¾" 18¾" 19¾" Back angling -90 -+30-90 -+30-90 -+30-90 -+30 Tilt in space -5 -+20 * -5 -+20-5 -+20-5 -+20 Foot support angle 90-75 90-75 90-75 90-75 Weight, total 31 lbs. 32 lbs. 36½ lbs. 37½ lbs. Weight, frame 25½ lbs. 25½ lbs. 27½ lbs. 27½ lbs. Weight, seat 5½ lbs. 6½ lbs. 9 lbs. 10 lbs. Max. load, total 77 lbs. 110 lbs. 132 lbs. 154 lbs. Max. load, seat 77 lbs. 110 lbs. 132 lbs. 154 lbs. Max. load, operating force 77 lbs. 77 lbs. 121 lbs. 121 lbs. * The -5 tilt is obtainable at 55 cm (19½") seat height above floor Page 5 of 5