Invacare eForms For additional information, visit www.invacare.com/eForms Customer Service: 800-333-6900 Fax: 800-678-4682 www.invacare.com To order Literature: 800-828-6282 Invacare eForms offer new functionality! Invacare is pleased to offer you an upgraded solution to your ordering process. Our enhanced order forms allow you to fill out a form electronically, print and fax the form, save and email* it to Customer Service, or maintain the business practices that work for you today. The format has been revised to reveal a cleaner look with electronic selection and input functions. *Saving and emailing the eForms is available with Acrobat Professional software If you are using Adobe Acrobat Professional If you are using Adobe Reader • View and download all forms • View and download all forms • Save blank versions of the forms to your desktop • Save blank AND completed versions of the forms to maintain electronic records • Complete forms electronically • Print blank or completed forms • Complete forms electronically • Fax completed forms to Customer Service • Print blank or completed forms • Fax completed forms to Customer Service • Email completed forms to Customer Service by using the 'Email' button at the end of the form. Please note: The 'Email' button at the end of the form will not work with Adobe Reader. The 'Email' button will only work while using Adobe Acrobat Professional. For information on downloading Adobe Reader for free, or puchasing Adobe Acrobat Professional, please visit www.adobe.com. NOTE: All specifications and dimensions are approximate. For the most current pricing information, go to www.invacare.com/homecare. Page 1 of 4 Invacare® IVC™ Tracer® SX5 Recliner Wheelchair Price List and Order Form Customer Service: 800-333-6900 www.invacare.com Fax: 800-678-4682 To order literature: 800-828-6282 TRANSACTION TYPE: Order Date Quote Account # P.O. # Company Name Phone # Address State 0 City Contact Name Zip Code Country Comments Special Note HCPCS codes are not intended to be, nor should be considered billing or legal advice. Providers are responsible for determining the appropriate billing codes when submitting claims to the Medicare Program and should consult an attorney or other advisor to discuss specific situations in further detail. PRE-CONFIGURED STOCK WHEELCHAIRS FRAMES STOCK CHAIRS Quantity Model ID CHAIR TYPE Price Description TRSX5RC Tracer SX5 Recliner Builder Wheelchair ........................ $695.00 TRSX5RC6 TRSX5RC/WD66/28/R/U67 (9153637779) ........ $1,135.00 FRAME WIDTH AND DEPTH TRSX5RC8 TRSX5RC/WD86/28/R/U67 (9153637778) ........ $1,135.00 STOCK FRONT RIGGINGS Quantity Model ID T93HA T93HC T94HA T94HC AHL4A T94HE T93HE Description Price Hemi Sw. Footrests Aluminum Footplates (9153637801) ...... $93.00 Hemi Sw. Footrests Composite Footplates (9153637786) ...... $93.00 Hemi Sw. Elev Legrests Aluminum Footplates (9153637804) .... $180.00 Hemi Sw. Elev Legrests Composite Footplates (9153637788) .... $180.00 Hemi Smart Leg Art. Legrest Aluminum (9153619911) ......... $320.00 Hemi Legrest Composite w/Black Non Rem Calfpad (9153637919) $110.00 Hemi Footrest without Loop Composite Footplate (9153637918) ........ $65.00 WD46 14" Wide x 16" Deep .......................................... $90.00 A9900 WD48 14" Wide x 18" Deep ........................................ $118.00 A9900 WD66 16" Wide x 16" Deep .....................................No Charge WD68 16" Wide x 18" Deep ........................................ $118.00 WD86 18" Wide x 16" Deep .....................................No Charge WD88 18" Wide x 18" Deep ........................................ $118.00 A9900 20" Wide x 16" Deep .................................... No Charge E2201 WD06 A9900 20" and 22" widths have 300 lbs. weight limit requiring 1228 casters (upcharge necessary, see "Casters" section), and 24" rear wheels (no upcharge). WD08 20" Wide x 18" Deep ........................................ $254.00 20" and 22" widths have 300 lbs. weight limit requiring 1228 casters (upcharge necessary, see "Casters" section), and 24" rear wheels (no upcharge). WD26 22" Wide x 16" Deep ........................................ $142.00 20" and 22" widths have 300 lbs. weight limit requiring 1228 casters (upcharge necessary, see "Casters" section), and 24" rear wheels (no upcharge). WD28 22" Wide x 18" Deep ........................................ $254.00 E2201 20" and 22" widths have 300 lbs. weight limit requiring 1228 casters (upcharge necessary, see "Casters" section), and 24" rear wheels (no upcharge). ARMS ARM TYPE All arm types below are removable, conventional and nonflip-back. 18 19 28 29 Full Length Fixed Height Conv. 10" ............ No Charge Full Length Adj. Height Conv. 10" - 14" ......... $130.00 Desk Length Fixed Height Conv. 10" .......... No Charge Desk Length Adj. Height Conv. 10" - 14" ........ $130.00 A9900 E0973 A9900 E0973 FRAME TYPE R Recliner Frame ................................................... $410.00 E1226 90 degree to 180 degree of recline. 24" back height with 10" headrest extension. NOTE: All specifications and dimensions are approximate. For the most current pricing information, go to www.invacare.com/homecare. Revised December 8, 2014 Page 2 of 4 Form No. 02-077 Invacare® IVC™ Tracer® SX5 Recliner Wheelchair COLOR OPTIONS ACCESSORIES UPHOLSTERY COLORS U240 U550 U67 U86 BACK ACCESSORIES L8601 Black Nylon Upholstery ......................................... No Charge Midnight Blue Vinyl Upholstery ............................... Standard Black Vinyl ............................................................ No Charge Ruby Red Vinyl ...................................................... No Charge STC Omit Back Upholstery .............................. Less $10.00 Stencil Back Upholstery .................................... $29.00 A9270 3/4 Block Letters. SEAT ACCESSORIES CASTERS L8651 CASTER OPTIONS AT903 1228 1252 4252 8" x 1.25" Composite Urethane ....................... Standard 8" x 1.75" Semi Pneumatic Casters Lt Grey ....... $56.00 8" x 1.25" Pneumatic Casters ............................. $87.00 8" x 1.25" Pneumatic Casters w/FF Inserts ...... $179.00 Omit Seat Upholstery ................................ Less $10.00 MISCELLANEOUS ACCESSORIES 1322SXR IV Rod and Bracket, Telescopic, Recliner ................ $110.00 1514 Overhead Anti Theft Device ....................................... $46.00 MUPH Matching Upholstery ............................................ No Charge A9900 Applys to arm pads and calf pads. 1329BK Toggle Wheel Lock Extension (8") ............................ $39.00 WHEELS FRONT RIGGING OPTIONS WHEEL OPTIONS U1763BK U1764BK 2244BK 4244BK U2222C U2244BK 20" Composite Urethane Tires ......................... $113.00 22" Composite Urethane Tires ......................... $113.00 24" Composite Pneumatic Tires ....................... $140.00 24" Composite Pneumatic with FF Inserts ....... $225.00 24" Composite Urethane Corded Tires ........... Standard 24" Composite Urethane Treaded Tires ........... $120.00 A9900 FRONT RIGGINGS A9900 A9900 Hemi Footrests without heel loop, Composite Ftpl .. $65.00 Hemi Footrests Aluminum Footplates ................. $93.00 T93HC Hemi Footrests ..................................................... $93.00 T94HE Hemi Elevating Legrest Composite Ftpl Blk Plastic Calf Pad $110.00 A9900 T94HA Hemi Elev. Lgrt Aluminum Ftpl ........................ $180.00 K0195 E0990 E2213 A9900 Not available with 14" wide. Not available with 14" wide. A9900 WHEEL LOCKS 9690B 9691B T93HE T93HA Not available with 14" wide. All calfpads are black. Pull To Lock Wheel Locks (Std on Hemi) ............. No Charge Push To Lock Wheel Locks (Std on Adult) ........... No Charge T94HC Hemi Elevating Legrests .................................... $180.00 K0195 E0990 Not available with 14" wide. All calfpads are black. HANDRIM OPTIONS COM AHL4A Hemi Smartleg Articulating Lgrt Alum Ftpl ...... $320.00 K0053 Not available with 14" wide. All calfpads are black. Composite Handrims ................................................. Standard Available with 24" rear wheels only. AHL4C AHDRM Aluminum Handrims ...............................................No Charge Hemi Smartleg Art. Lgrt Comp Ftpl .................. $320.00 K0053 Not available with 14" wide. All calfpads are black. Not available with U2222C rear wheels. AHS4A Hemi Smartleg Art. Lgrt-14" W Chairs ............. $320.00 K0053 All calfpads are black. POSITIONING STRAP OPTIONS T93HS T94HS SEAT POSITIONING STRAPS 1515 Push Button Style Positioning Strap .................... $50.00 A9900 E0978 1321BK Hook and Loop Seat Positioning Strap ............... $40.00 E0978 Hemi Footrests Aluminum Footplates 14" W ...... $90.00 Hemi Legrests Aluminum Footplates 14" W ..... $175.00 A9900 A9900 All calfpads are black. FOOTPLATE TYPE 1350 Extra Large Footplates ....................................... $79.00 K0041 Not available on 14" width. AT5543 Adjustable Angle Flip-Up Footplates ................ $67.00 FOOTREST/LEGREST ACCESSORIES 1820 1346 Non-Removable Device ..................................... $12.00 Heel Loops ......................................................... $39.00 A9900 K0951 Standard on swingaway footrests T93HA and T93HC. NOTE: All specifications and dimensions are approximate. For the most current pricing information, go to www.invacare.com/homecare. Revised December 8, 2014 Page 3 of 4 Form No. 02-077 Invacare® IVC™ Tracer® SX5 Recliner Wheelchair TRACER SX5 RECLINER CONVERSION KITS Standard on SX5 Recliner • Rear anti-tippers • Patient only operated push-to-lock wheel lock These selections do not include seat upholstery or clamp-on wheel locks required for 20" or 22" rear wheels. Quantity Model ID RCL14 Price Description 14” Wide Conversion Kit ....................................... $420.00 Includes AT903 casters and Heavy-Duty forks. RCL16 Weight Limitation 250 lbs., 300 lbs. 20" & 22" width Invacare recommends all wheelchairs be fitted to the consumer under the guidance of a healthcare professional, knowledgeable of the particular limitations of the product. 16” Wide Conversion Kit ....................................... $420.00 Includes AT903 casters and Heavy-Duty forks. RCL18 18” Wide Conversion Kit ....................................... $420.00 Includes AT903 casters and Heavy-Duty forks. RCL20 20” Wide Conversion Kit ....................................... $390.00 RCL22 22” Wide Conversion Kit ....................................... $390.00 Seat-to-Floor 8" Casters Seat-to-Floor Height Front Caster Rear Wheel Rear Wheel Size Mounting Position Mounting Position 17 1/2" Top 20" Recliner Axle Mounting Bracket 18 1/3" Middle 22" Recliner Axle Mounting Bracket 19 1/2" Bottom 24" Recliner Axle Mounting Bracket Comments Print Form Email Form Clear Form NOTE: All specifications and dimensions are approximate. For the most current pricing information, go to www.invacare.com/homecare. Invacare Corporation USA One Invacare Way Elyria, OH USA 44035-4190 800-333-6900 www.invacare.com ©2013 Invacare Corporation All rights reserved. Trademarks are identified by the symbols™ and ®. All trademarks are owned by or licensed to Invacare Corporation unless otherwise noted. Specifications and prices are subject to change without notification. Page 4 of 4 Revised December 8, 2014 Form No. 02-077
* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project
advertisement
© 2021