Manual Wheelchair Retail Prescription Form ReaAzaleaTransit281117 Tel: 01656 776222 Fax: 01656 776220 Email: ordersuk@invacare.com January 2018 Online spares available at: www.invacare.co.uk Customer Ref: Account No : Contact No: Delivery address : Order Qty : Order Date : X Please make your selection with a cross in the box Standard feature Free of Charge Customer weight = Kg Code Description NC's (Non Conformance) Retail BNE9002 X Rea Azalea Transit 2,026 BNZ9002 Rea Azalea Transit Special Basic Model - PLEASE COMPLETE DETAILS AT THE END OF THE FORM POA PROPULSION TYPE BNE0020 X Equipped with 16" transit wheels inc. hub brakes SEAT DIMENSIONS SEAT WIDTH BNE0040 390mm (15") ( Small chassis) BNE0050 440mm (17") ( Medium chassis) BNE0060 490mm (19") ( Large chassis) (NC : 0206) SEAT WIDTH ADJUSTMENT (PRE ADJUSTMENT) BNE0085 Without seat width extension (Set at 0mm adjustment but can be adjusted wider if required) (NC: 0206) BNE0065 + 50mm seat width pre adjustment BNE0075 + 100mm seat width pre adjustment, fitted with larger cushion (NC : 0110) SEAT DEPTH ADJUSTABLE Invacare ransit RETAIL Max User Weight 135Kg (21 stone) Standard Features Transit Propulsion 16" Solid Tyre Transit Wheels Including Hub Brakes Choice of Seat Widths 390mm to 490mm (+50mm and +100mm) Choice of 2 Seat Heights 400mm or 450mm Depth Adjustable Seat 430mm 500mm Flex 3 Backrest Plate, Passad 2 Cushion with Braced Push Handles Assistant Operated Gas Piston Seat and Backrest Recline with Tilt Lock Angle Adjustable Legrests with Calf Support Height Adjustable Wide Pad Armrests (including autolock) Sideways Adjustable Headrest Pearl Silver Frame User Manoeuvred Tyre Brakes, Pelvic Belt, Anti Tippers Standard Base Price: 2,026 BNE0100 X 430-500mm (17" - 20") SEAT HEIGHT BNE0110 400mm (16") Not to combine with 200mm castors and long footrest tubes. (NC : 0370; 0520; 0580; 1000; 1010; 1035) BNE0120 450mm (18") SEAT ANGLE BNE0127 Negative Seat angle -1º to +23º (std +1º to +25º) (NC : 0360) SEAT TYPE BNE0130 Depth adjustable 430-500mm (17" - 20") SEAT CUSHION BNE0165 Cushion Floshape 49 BNE0170 Cushion Vicair Multifunctional Black (NC: 0201; 0202) 519 BNE0180 Without seat cushion SEAT UPHOLSTERY BNE0201 Black dartex TR26 BNE0202 Black spacer TR36 Page 1 of 5
FLEX 3 BACKREST BACKREST WIDTH ADJUSTMENT (PRE ADJUSTMENT) (NC: 0221; 0223; 0225;0228) BNE0205 +50mm width pre adjustment, fitted with larger cushion If selecting this option on the Tension adjustable backrest, the +50mm seat width adjustment must also be selected BNE0206 +100mm width pre adjustment, fitted with larger cushion (NC : 0220; 0221; 0223; 0225; 0228) BNE0207 Without width pre adjustment (Set at 0mm adjustment but can be adjusted wider if required) BACKREST TYPE BNE0210 Backrest plate - Flex 3 width and height adjustable 560mm - 790mm (NC : 0233; 0234; 0343; 0240; 0771,0905) BNE0220 Tension adjustable - Flex 3 width and height adjustable 540mm - 715mm (NC : 0233; 0234; 0343; 0925; 0771) 87 BNE0221 BNE0223 BNE0225 BNE0228 Matrx Elite TR, includes hardware mounted to frame, backrest BNF0233 Matrx backrest height 410mm BNF0234 Matrx backrest height 510mm BACKREST COVER/ CUSHION BNE0240 Cover, for tension adjustable upholstery BNE0250 Cushion, Laguna (lateral support) (NC : 0905) BNE0260 Cushion, Mistral 2 (waist support) (NC : 0322; 0905) 123 BNE0270 Cushion, Passad 2 (shoulder support) (NC : 0905) BNE0280 Cushion, Shoulder High 05 (dartex) (NC : 0322; 0905) 128 BNE0290 Cushion, Vicair Multifunctional Black (NC : 0321; 0322; 0905) 499 BNE0300 Without backrest cushion, select with Matrx backrest options (NC : 0905) BACKREST UPHOLSTERY BNE0321 Black dartex TR26 BNE0322 Black spacer TR36 PUSH HANDLES BNE0335 Push handles connected BNE0343 Push handles connected to fit Rea head/neck rests in combination with Matrx backrest (NC: 0771) 61 BNE0345 Push bar, angle adjustable 87 SEATING SEAT TILT AND BACKREST REGULATION TYPE BNE0350 Assistant operated gas piston seat and backrest tilt. BNE0360 Electrical operated seat and backrest tilt. (NC : 0370) 625 LEGRESTS / FOOTRESTS CENTRAL LEGRESTS TYPE Matrx Elite, includes hardware mounted to frame, backrest Matrx Elite deep, includes hardware mounted to frame, backrest Matrx Posture, includes hardware mounted to frame, backrest BACKREST HEIGHT MATRX BACKRESTS (Select required height with Matrx backrests only) 406 450 406 335 BNE0370 Central legrest, incl calfpad and footrest. Not to combine with separate footrest lower parts, abduction cushion, footplate extender and clinic kit. (NC : 0375; 0376; 0380; 0390; 0400; 0410; 0430; 0440; 0450; 0460; 0475; 0477; 0480; 0490, 0520; 0540; 0550; 0580; 0720; 0930; 0940; 0941; 0942; 0945; 1290) 259 LEGREST/HANGER POSITION BNE0375 Standard position for legrest mounting Standard High BNE0376 High position for legrest, mounted 50mm higher Position Position LEGRESTS / HANGERS LH TYPE BNE0380 Hanger angle adjustable - alu 2008 LH. With knee pad and calf support (NC : 0942; 0945) BNE0390 Hanger fixed 80 deg, swing in swing out - alu 2003, LH (NC: 0950) BNE0400 Hanger fixed 90 deg, swing in swing out - alu 2003, LH (NC : 0480; 0520; 0930; 0950; 1000; 1010; 1035) BNE0410 Legrest amputee - alu 2008 LH (NC : 0475; 0477; 0480; 0490; 0941; 0942; 0520; 0930; 0945) 117 LEGRESTS / HANGERS RH TYPE BNE0430 Hanger angle adjustable - alu 2008 RH. With knee pad and calf support (NC : 0942; 0945) BNE0440 Hanger fixed 80 deg, swing in swing out - alu 2003, RH (NC: 0950) BNE0450 Hanger fixed 90 deg, swing in swing out - alu 2003, RH (NC : 0540; 0580; 0940; 0950; 1000; 1010; 1035) BNE0460 Legrest amputee - alu 2008 RH (NC : 0475; 0477; 0540; 0550; 0580; 0940; 0941; 0942; 0945) 117 FOOTRESTS ONE PIECE BNE0475 Footrest one piece depth and angle adjustable short tube (NC : 0477; 0480; 0490; 0520; 0540; 0550; 0580; 0930; 0940) 101 FOOTBOX BNE0477 Footbox, angle adjustable, padded with short tube (NC: 0480; 0490; 0520; 0540; 0550; 0580; 0930; 0940; 0941; 0942; 0945) 465 Page 2 of 5
FOOTRESTS LH TYPE BNE0480 BNE0490 BNE0520 FOOTRESTS RH TYPE BNE0540 BNE0550 BNE0580 ARMRESTS Short tube knee to heel range 290mm - 400mm, Long tube 370mm - 500mm Footrest lower part, fixed with short tube and heel strap, LH. Not to combine with footplate extender. Footrest lower part, depth and angle adjustable with short tube and heel strap, LH Footrest lower part, depth and angle adjustable with long tube and heel strap, LH Footrest lower part, fixed with short tube and heel strap, RH. Not to combine with footplate extender. Footrest lower part, depth and angle adjustable with short tube and heel strap, RH Footrest lower part, depth and angle adjustable with long tube and heel strap, RH (NC : 0930; 0941; 0945) Short tube knee to heel range 290mm - 400mm, Long tube 370mm - 500mm (NC : 0940; 0941; 0945) ARMRESTS LH TYPE BNE0600 Height adjustable, ducktail pad, LH (Autolock armrest included) BNE0605 Height adjustable, wide pad, LH (Autolock armrest included) BNE0607 Height adjustable and reinforced, wide pad, LH (Autolock armrest included) (NC : 1230, 1231, 1250, 1260) 76 BNE0610 Height adjustable padded, LH. Not possible to combine with standard table.( Autolock armrest included) (NC : 0680; 0690; 1230; 1231; 1250; 1260) 54 BNE0615 Hemiplegic armrests, LH. Not to combine with table accessories. (Autolock armrest included) (NC : 0695; 1230; 1231; 1240; 1245; 1250; 1260) 153 ARMRESTS RH TYPE BNE0630 Height adjustable, ducktail pad, RH (Autolock armrest included) BNE0635 Height adjustable, wide pad RH (Autolock armrest included) BNE0637 BNE0640 Height adjustable and reinforced, wide pad, RH. ( Autolock armrest included) Height adjustable padded, RH. Not possible to combine with standard table.( Autolock armrest included) (NC : 1230, 1231, 1250, 1260) 76 (NC : 0680; 0690; 1230; 1231; 1250; 1260) 54 BNE0645 SEATING OPTIONS Hemiplegic armrests, RH. Not to combine with table accessories. (Autolock armrest included) (NC : 0695; 1230; 1231; 1240; 1245; 1250; 1260) 153 ARMREST OPTIONS BNE0680 Side support cover, cover only over sideguard, removable with tools (NC: 0695) 44 BNE0690 Cushion to side support cover (Side support cover must also be choosen) (NC: 0695) BNE0695 Pad for siderest - removable pad with velcro straps 44 SEAT OPTIONS BNE0710 Incontinence cover 34 BNE0720 Abduction/Pommel cushion 101 BNE0725 Scale for seat tilt 38 BACKREST OPTIONS BNE0730 Headrest, sideways adjustable (NC : 0770; 0780) BNE0740 Cover for headrest (NC: 0750) 26 BNE0750 Headrest with cheek support, sideways adjustable (NC : 0770; 0780) 92 BNE0770 Neckrest BNE0771 Headrest Matrx, 250mm soft pad (NC: 0780; 0790) 159 BNE0780 Cover for neckrest 18 BNE0782 Alternative headrest/neckrest mounting bracket 19 BNE0790 Handles clinic kit for head/neckrest BNE0800 Trunk support multi adjustable with standard arm (LH) (NC : 0900) BNE0810 Trunk support multi adjustable with standard arm (RH) (NC : 0900) BNE0820 Trunk support multi adjustable with extended arm in height (LH) (NC : 0900) BNE0830 Trunk support multi adjustable with extended arm in height (RH) (NC : 0900) BNE0880 Trunk support swingaway (LH) (NC : 0900) 90 BNE0890 Trunk support swingaway (RH) (NC : 0900) 90 BNE0895 Trunk support multi adjustable swingaway (LH) (NC : 0900) 97 BNE0896 Trunk support multi adjustable swingaway (RH) (NC : 0900) 97 BNE0900 X Trunk support attachment. If trunk supports are choosen above, the attachment bracket is already included BNE0905 Lateral positioning pads (Pair). Attaches with velcro between the straps and the cover of the tension adjustable upholstery 52 BNE0910 Lumbar support cushion 26 BNE0915 Scale for backrest recline 38 BNE0920 Wedges (one pair) 9 BNE0925 Privacy attachment (material connecting backrest and seat) 29 Page 3 of 5
LEGREST OPTIONS BNE0930 Footplate extender LH (NC : 0941) 29 BNE0940 Footplate extender RH (NC : 0941) 29 BNE0941 Footplate cover, plush material 46 BNE0942 Calf strap (padded) 62 BNE0945 Calf strap (for one piece footrest only) CHASSIS CHASSIS COLOUR BNE0944 Silver Pearl BNE0946 Azurite (dark blue) BNE0947 Sand BNE0948 Green For the sand, green and red frame colours, please allow an extra 5 days leadtime. BNE0949 Red CHASSIS SAFETY BNE0950 Chassis extender, castors 50mm forward. CASTOR ATTACHMENT TYPE BNE0960 X Fixed FRONT CASTORS BNE0970 140mm x 40mm (5.5" x 1.5") soft 17 BNE0985 150mm x 30mm (6" x 1.25") medium hard 17 BNE0990 150mm x 30mm (6" x 1.25") soft BNE1000 200mm x 27mm (8" x 1") medium hard 17 BNE1010 200mm x 30mm (8" x 1.25") soft BNE1035 200mm x 45mm (8" x 1.75") medium hard TYRE TYPE BNE1090 X Tyres solid SAFETY BRAKE TYPE BNE1170 X User manoeuvred tyre brakes SAFETY OPTIONS BNE1200 X Pelvic belt BNE1220 Reflectors kit (wheels and chassis) 18 BNE1225 Transportation brackets, mounted to the front of the wheelchair 12 ACCESSORIES BNE1230 Table tray without elbow pads incl mounting kit (NC : 1260) 118 BNE1231 Table tray with elbow pads incl mounting kit (NC : 1260) 118 BNE1235 Cushion for table tray (NC : 1240; 1245) 44 BNE1240 Swing away table without elbow pads (NC : 1250; 1260) 130 BNE1245 Swing away table with elbow pads (NC : 1250; 1260) 130 BNE1250 Locking device for table tray (NC : 1260) 12 BNE1260 Mounting kit for table (if ordered separately) 7 BNE1263 X Tilt lock (Locking of pre-set angle) BNE1270 Pump 18 BNE1280 Cane holder 43 BNE1290 Clinic kit 47 BNE1300 Harness attachment (headrest or neckrest must be selected) 74 BNE1305 Front castor lock (allows castors to remain parallel) 159 BNE1310 Attachment for positioning belt, fitted to seatframe 27 SPECIALS BNE8010 Special Comment PLEASE COMPLETE DETAILS AT THE END OF THE FORM Non Conforming Options: BNE0110 40 cm. Not to combine with 200 mm castors and long footrest tubes. BNE0201 Black datrex fabric TR35 BNE0202 Black spacer fabric TR36 BNE0206 Plus 100mm width pre-adjustment BNE0220 Tension adjustable - Flex 3 width and height adjustable BNE0221 MatrX Elite BNE0223 MatrX Elite Deep BNE0225 MatrX Posture Back BNE0227 MatrX Posture Back Deep BNE0233 Matrx backrest height 410mm BNE0234 Matrx backrest height 510mm BNE0240 Cover for tension backrest BNE0290 Cushion, Vicair Multifunctional Black Total Price: Page 4 of 5
BNE0321 BNE0322 BNE0360 BNE0370 BNE0375 BNE0376 BNE0380 BNE0390 BNE0400 BNE0410 BNE0430 BNE0440 BNE0450 BNE0460 BNE0475 BNE0477 BNE0480 BNE0490 BNE0520 BNE0540 BNE0550 BNE0580 BNE0680 BNE0690 BNE0695 BNE0720 BNE0750 BNE0770 BNE0771 BNE0780 BNE0790 BNE0900 BNE0905 BNE0925 BNE0930 BNE0940 BNE0941 BNE0942 BNE0945 BNE0950 BNE1000 BNE1010 BNE1035 BNE1230 BNE1231 BNE1240 BNE1245 BNE1250 BNE1260 BNE1290 Black dartex TR26 Black spacer TR36 Electrical operated seat and backrest tilt. Central legrest, incl calfpad and footrest. Not to combine with separate footrest lower parts, abduction cushion, footplate extender and clinic kit. Standard position for legrest mounting High position for legrest, mounted 50mm higher Hanger angle adjustable - alu 2008 LH. With knee pad and calf support Hanger fixed 80 deg, swing in swing out - alu 2003, LH Hanger fixed 90 deg, swing in swing out - alu 2003, LH Legrest amputee - alu 2008 LH Hanger angle adjustable - alu 2008 RH. With knee pad and calf support Hanger fixed 80 deg, swing in swing out - alu 2003, RH Hanger fixed 90 deg, swing in swing out - alu 2003, RH Legrest amputee - alu 2008 RH Footrest one piece depth and angle adjustable short tube Footbox Footrest lower part, fixed with short tube and heel strap, LH. Not to combine with footplate extender. Footrest lower part, depth and angle adjustable with short tube and heel strap, LH Footrest lower part, depth and angle adjustable with long tube and heel strap, LH Footrest lower part, fixed with short tube and heel strap, RH. Not to combine with footplate extender. Footrest lower part, depth and angle adjustable with short tube and heel strap, RH Footrest lower part, depth and angle adjustable with long tube and heel strap, RH Side support cover Cushion to side support cover Pad for siderest Abduction cushion Headrest with cheek support, sideways adjustable Neckrest Headrest Matrx, 250mm soft pad Cover for neckrest Handles clinic kit for head-/neckrest Trunk support attachment Lateral positioning pads. Attaches with velcro between the straps and the cover of the tension adjustable upholstery Privacy attachment Footplate extender LH Footplate extender RH Footplate cover, plush material Calf strap (padded) Calf strap (for one piece footrest only) Chassis extender, castors 5cm forward. 200x27 medium hard 200x30 soft 200x45 medium hard Table tray without elbow pads incl mounting kit Table tray with elbow pads incl mounting kit Swing away table without elbow pads Swing away table with elbow pads Locking device for table tray Mounting kit for table (if ordered separately) Clinic kit Please refer to our Invacare Unique special order form, for more complex custom requirements. Available at www.invacare.co.uk Special Instructions Please supply the following information: Name: Phone: Email: Fax: Description of special request (please include relevant option code or part number): Page 5 of 5