Quickie | Pulse | Pulse 6 Order Form - Quickie

Quickie Pulse™ 6 Group 3
(K0848, K0849, K0856)
SUBMIT
EIPW22, November 2012
Account:
Date:
PO#:
Buyer:
Marked For:
Ship To:
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Address:
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The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.
The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify with the appropriate payer's coverage policy.
D
Option #
HCPCS
Definition
D
Price
Option #
HCPCS
Definition
1. QUICKIE Pulse™ 6 GROUP 3 CATEGORY (Select One)
QUICKIE Pulse™ 6 BC (Group 3 K0848/K0011)
† Quickie Pulse™ 6 BC w/ASAPII Seat (Fig 1.1)
195PC74
K0848
K0011
$5,765.00
Base Package
VR-2 90A Drive Control (non-expand)
300 lb 6 mph 4-pole Motor Package
ASAP II Seat Frame
13" Drive Wheels (flat free insert N/C)
8A Dual Mode Charger (Compact) CTE
Pulse™ 6 BC BASE ONLY
For use with Aftermarket Seat frame.
† 195NB83
K0848
† 195EQ08
-
Pulse™ 6 BC SEAT ONLY w/o elect.
For use to add/replace seating when
additional electronics are not required.
$750.00
† 195EQ11
-
Pulse™ 6 BC SEAT ONLY w/ elec.
For use to add/replace seating when
additional electronics are required.
$750.00
$5,765.00
Fig 1.1 Pulse™ 6 BC
ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com
Page 1
Price
2. BASE CHAIR OPTIONS
Shroud Color
Transit Option
†
195EZ01
-
Candy Apple Red
N/C
†
195EZ02
-
High Gloss Black
N/C
†
195EZ03
-
Candy Blue
N/C
Drive wheel/tire package
†
195DW53
-
Black/Chrome Wheel, Knobby Tire.
†
195DW42
-
Black solid Wheel, groove tire.
†
195TO40
-
Omit Transit
$300.00
$315.00
NC
†
195TO25
-
ISO Transit Package ( N/A with Vent or Capt
seat)
†
195WN01
-
WC19 Transit Package (Capt Seat only,
order belt separately below.
Std
-$20.00
WC19 Transit Lap Belt
†
195WN02
WC19 Transit Lap Belt
$200.00
User weight
† 195WG06
-
< 150lb.
N/C
† 195WG13
-
151-200lb
N/C
†
195FA10
-
0°
† 195WG14
-
201-250lb
N/C
†
195FA3
-
3°
NA with +3" or +4" STFH or lift
N/C
† 195WG03
-
251-300lb
N/C
†
195FA4
-
6°
NA with +3" or +4" STFH or Lift/Tilt
N/C
Ventilator Options
Pre-Set Seat Frame Angle
Seat Height
(Measured in the front) - Obtain Quote to verify est. STFH
Not available w/ Transit, Power Legs or Capt seat.
†
195VT4
E1029
Fixed Vent Tray
(Pulmonetic LTV Models)
$440.00
Motor Package
†
195PF88
-
N/C
300lbs 6mph 4-Pole
Std
†
†
†
†
†
Lowest STFH
+1" Seat to Floor Height
+2" Seat to Floor Height
195HT44
195HT45
195HT46
195HT47
+3" STFH
+4" STFH
195HT48
NA with Capt Seat
NA with Capt Seat
NC
NC
NC
NC
NC
STFH Matrix
Seating Type and
Power Option Combinations
Seat-to-Floor Height at 0 tilt
Low
+1"
+2"
+3"
+4"
ASAP II No power seating.
16.2"
17.2"
18.2"
19.2"
20.2"
ASAP II Lift only.
18.6"
19.6"
ASAP II with Tilt
17.8"
18.8"
19.8"
Captain Seat (From Pan)
16.2"
17.2"
18.2
Captain Seat with Lift. (From Pan)
18.4"
19.4"
21.2"
22.2"
20.8"
21.8"
NA
NA
NA
NA
Adding seat angle will increase STFH by 1" for each
incremental change.
3. BATTERIES and CHARGERS
Batteries
Battery Charger
†
195AG01
E2361
†
195AG05
-
22NF Std post Batteries (Pair) w/straps
Omit batteries (Includes harness)
$320.00
†
195BJ19
-
8A Dual Mode Charger (Compact) CTE
N/C
†
195BJ3
-
Omit Charger
ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com
Page 2
N/C
-$40.00
4. ELECTRONICS
Drive Control Options
†
-
195ER01
Non-expandable controller and joystick
Specialty Driver Control Options
N/C
$950.00
Requires expandable controls and OMNI. All packages must be added to the specialty
control on-chair package. Not available with Upholstered backs or the Captains seat.
195EX01
E2377
Expandable Controller - R-net
$525.00
† Quickie Sip n' Puff System
195EX02
E2313
Harnessing for Expandable Controller
$425.00
† R-Net Expandable Drive Control Upgrade (90A)
R-net Joystick (for expandable electronics)
†
195J70
†
195J93
†
195J88
†
195J95
-
Std LED Joystick for Expandable Ctrls
N/C
Joystick w/stereo Jacks and
Monochrome Display
$200.00
-
Joystick W/Toggle, Spd Pot, Stereo Jacks
& Color Display
$395.00
-
Omit JS for use with OMNI
195JM10
-
†
195JM11
E1028
Fixed Mount
Swing Away Mount
Sip N' Puff Kit
195II01
E0955
Headrest
195IJ01
E1028
Headrest Removable Mount
$225.00
195IH1
E2326
Sip n' Puff Tubing and Hardware
$364.00
195II02
E2330
ASL Proximity Head Array (Adult)
195IJ01
E1028
Headrest Removable Mount
† ASL Head Array Package (Ped)
195II03
E2330
ASL Proximity Head Array (Ped)
195IJ01
E1028
Headrest Removable Mount
† Switch-It Head Array Package (Adult)
Joystick Mount (Fixed or Swing Away)
†
E2325
† ASL Head Array Package (Adult)
N/C
N/C
195II04
E2330
Switch-it Proximity Head Array
$235.00
195IJ01
E1028
Headrest Removable Mount
† Switch-It Head Array Package (Pediatric)
Joystick Mount (Location)
Captain Seat Not Height Adjustable, ASAP II = Height Adjustable.
†
195HM1
-
Right Side Mount
N/C
†
195HM2
-
Left Side Mount
N/C
†
195JH1
E2323
Ball Handle
$75.00
†
195JH2
E2323
Foam Ball Handle
$75.00
†
195JH4
E2323
T-Handle
$75.00
†
195JH6
E2323
Goalpost
$75.00
†
195ON1
†
195ON2
†
195ON3
-
Rnet Bluetooth Mouse-mover
E2330
Switch-it Proximity Head Array
195IJ01
E1028
Headrest Removable Mount
$1,420.00
$225.00
$4,020.00
$3,795.00
$225.00
$4,020.00
$3,795.00
$225.00
$4,020.00
$3,795.00
$225.00
$4,020.00
$3,795.00
$225.00
$4,945.00
$4,495.00
195ID36
E2312
Mini Joystick
195II01
E0955
Headrest
$225.00
195IJ01
E1028
Headrest Removable Mount
$225.00
ASL Proportional Mini Joystick
†
Midline with Gatlin Package
195ID37
E2312
Mini joystick
195IJ03
E1028
ASL Proportonal S/A Joystick Mount
† Quickie Proportional Chin Control Package
R-net OMNI and Output Options
(For expandable controls, choose all that apply)
Rnet OMNI Input Control Module and
display with built in Infrared and armrest
mount. Choose mount below. (required for
Specialty Input Devices.)
E2351 Rnet Output Module (ECM)
195II05
ASL Proportional Mini Joystick
†
Chin / Lip Control Package
Joystick Handle (Optional)
$2,234.00
195ID34
195ID45
E2312
Proportional Joystick
195IJ03
E1028
ASL Proportonal S/A Joystick Mount
$4,720.00
$4,495.00
$225.00
$4,345.00
$4,120.00
$225.00
$975.00
$995.00
$850.00
OMNI Mount
(If used with Joystick must be mounted opposite side)
†
195DS03
E1028
Swing Away Left Side OMNI Mount
$235.00
†
195DS04
E1028
Swing Away Right Side OMNI Mount
$235.00
Switch inputs for Joysticks or OMNI
Drive or Mode / Profile Control (Avail Rnet only)
†
195SW22
Stereo to 2 Mono Splitter
$60.00
†
195SW6
Ribbon Switch
$95.00
†
1950A01
E2331
Attendant Control for VR-2
$995.00
†
195SW1
Buddy Button Switch
$75.00
†
1950A02
E2331
Attendant Control for R-net
$995.00
†
195SW2
Disc Switch
$160.00
†
195SW9
Wobble Switch
$500.00
†
195SW4
Micro Light Switch
$75.00
†
195DN1
Mounting location: Right Back Cane
N/C
†
195SW24
Egg Switch-Black
$95.00
†
195DN2
Mounting Location: Left Back Cane
N/C
†
195SW21
Dual toggle switch only
$170.00
195SW23
4-way toggle switch w/5th button DB9
Connector. (must have OMNI)
$170.00
†
Switch Mount Bracket
†
195EM01
Single Switch Mount Bracket
$195.00
†
195EM02
Dual toggle switch mount bracket
$195.00
†
195EM03
4-way toggle switch mount bracket.
$195.00
Attendant Control (NA with Capt Seat)
Attendant Mounting location
Electronic Programmers
†
195PR2
VR-2 Hand Held Programmer (HHP)
†
195PR5
R-net PC Programmer with Dongle
†
195PR6
DTT VR2 and Rnet cables included.
ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com
Page 3
$250.00
$400.00
$1,000.00
5. SEAT TYPE
†
195ST56
Quickie A.S.A.P II
(Adjustable Seating and Positioning)
Choose Seat Frame Size Platform.
-
Captain Seat w/Semi-Recline Back Standard with integrated seat pan, (K0849
cushion available in section 7.)
Choose Seat depth / width in section 6.
( D,E,F )
N/C
†
-
OR
ASAP II Frame size
195ST58
(each frame is width and depth adjustable within given range. )
†
195FU17
-
Adjustable 12x12 to 16X19 ( A )
N/C
†
195FU18
-
Adjustable 16x12 to 20x20 ( B )
N/C
†
195FU19
-
Adjustable 18x16 to 22x22 ( C )
N/C
N/C
6. SEAT SIZE
Seat Size Matrix. Seat type is chosen in section 5.
A = ASAP II Seat Frame Adjustable from 12x12 to 16X19
D = Captain Seat, Adjustable 16x15 to 16x18.
B = ASAP II Seat Frame Adjustable from 16X12 to 20X20
E = Captain Seat, Adjustable 18x16 to 18x20.
C = ASAP II Seat Frame Adjustable from 18X16 to 22X22
F = Captain Seat, Adjustable 20x18 to 20x22
ASAPII Seat Width
Capt Seat Width
12"
A
A
A
A
A,B
B
B
B
B
13"
A
A
A
A
A,B
B
B
B
B
14"
A
A
A
A
A,B
B
B
B
B
15"
A
A
A
A
A,B
B
B
B
B
16"
A
A
A
A
A,B
B
B,C B,C B,C
C
17"
A
A
A
A
A,B
B
B,C B,C B,C
C
18"
A
A
A
A
A,B
B
B,C B,C B,C
C
19"
A
A
A
A
A,B
B
B,C B,C B,C
C
B
B
B,C B,C B,C
20"
16" 18"
Seat Depth
Seat Depth
12" 13" 14" 15" 16" 17" 18" 19" 20" 22"
15"
D
16"
D
E
17"
D
E
18"
D
20"
E
F
19"
E
F
C
20"
E
F
21"
C
C
C
C
21"
F
22"
C
C
C
C
22"
F
Seat Width
Seat Depth
† 195R21
12" Seat width
N/C
† 195RF20
12"
Seat depth
N/C
† 195R22
13" Seat width
N/C
† 195RF21
13"
Seat depth
N/C
† 195R23
14" Seat width
N/C
† 195RF22
14"
Seat depth
N/C
† 195R24
15" Seat width
N/C
† 195RF23
15"
Seat depth
N/C
† 195R5
16" Seat width
N/C
† 195RF5
16"
Seat depth
N/C
† 195R6
17" Seat width
N/C
† 195RF6
17"
Seat depth
N/C
† 195R7
18" Seat width
N/C
† 195RF7
18"
Seat depth
N/C
† 195R8
19" Seat width
N/C
† 195RF8
19"
Seat depth
N/C
† 195R9
20" Seat width
N/C
† 195RF24
20"
Seat depth
N/C
† 195R25
22" Seat width
N/C
† 195RF25
21"
Seat depth
N/C
† 195RF26
22"
Seat depth
N/C
7. SEAT CUSHIONS
†
195CU34
Capt seat Cushion. (Avail on CC only)
†
195CU1
2" Cushion.
JAY Cushions (Optional)
NC
$95.00
To order any JAY cushions on-chair, please see the JAY price list.
Cushion name or part number must be filled out w/ desired width & depth
JAY Bundled Cushion
† 195JC20 Cushion Name or Part #
Price List
Width:
Depth:
ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com
Page 4
8. POWERED SEATING
Power Seating Options (SC Models)
†
195PJ2
E1002
Powered Seating Control Method - Cont.
Quickie SPOT 50° CG Tilt (NA with Capt
Seat)
$4,950.00
Switch Control 2 - 3 Actuator w/ 4-way
Toggle Switch & Mount. (Capable of operating combo of Tilt/Legs, Lift/Legs or legs
only)
†
195EO12
†
195EO13
E2310
Thru Drive 1 Actuator
(For operating Tilt or Lift thru Joystick.)
$1,375.00
†
195EO14
E2311
Thru Drive 2+ Actuators (2+ actuators per
Input Device requires expandable Rnet)
$2,825.00
Powered Seat Elevator- 9" Travel (NA with Tilt)
†
195PA8
E2300
Power Seat Elevate (adds 3" to STFH)
$2,500.00
Powered Seating Control Method
(For use with power seating actuators. Switch activation is stand-alone and does not
require expandable or thru-drive electronics.
†
†
195EO10
Switch Control 1 actuator w/dual toggle and
mount. (For operating Tilt or Lift)
195EO11
Switch Control 1 actuator w/buddy button &
mount.(For operating Tilt or Lift)
N/C
N/C
N/C
Switch Mount
(for use with switch control powered seating)
†
195EY01
-
Switch Mount Right
N/C
†
195EY02
-
Switch Mount Left
N/C
9. BACKREST AND BACK OPTIONS FOR ASAP II SEAT
Not available with Captain Seat
Backrest Frame Type
†
195BT8
† 195BT98
E1225
Back Type (Uphostery or Solid)
Angle Adjustable
N/C
Manual Recline 40° (not width adjust.)
$425.00
Manual Recline Adjustment Method Option
Back Height 23". Fits all seat types. NA with Cantilever Arms
†
195BU70
E2611
†
195BU71
E2611
Tension adj Upholstery 3DX Vented. w/1"
width adjustment. (NA with tilt)
195BU76
-
195BU77
E2613
Jay SPO Posterior
195BU78
E2617
ART SPO Custom Back See appendix 1
195BU14
-
195MN01
Tool
N/C
†
195MN02
Knob (NA with dual post arms.)
N/C
†
†
(NA with Manual recline)
195OD8
Non-Folding Backrest
†
195OD9
Folding Backrest
N/C
Upholstery (Not avail with tilt or Adj cane)
†
†
†
-
Tension adj Upholstery Ballistic Nylon. w/1"
width adjustment. (NA with tilt)
†
Angle Adjustable Backrest Options
195BU1
†
N/C
$315.00
$330.00
S.P.O.T. Curved
N/C
$475.00
See Pg 8
-$15.00
Omit Upholstery
$110.00
Jay 3 Option
†
Cane Angle
† 195BP40
Straight Back Post
†
8o Bend Back Post (Avail. only w/ Uph or
J3 Back) NA with Manual recline
195BP41
195JB01
xxx
Jay J3 (select OMIT above)
See J3 OF
N/C
$100.00
Cane Adjustable height
Back Height - Required for SPOT Curved and SPO Backs.
(Limited combinations of widths) Measured from pan to top of solid back.
†
195B132
-
14"
N/C
†
195B36
-
16"
N/C
†
195B38
-
18"
N/C
195B1
Fixed Low (15.5")
N/C
†
195B40
-
20"
N/C
†
195B5
Fixed Med (17.5")
N/C
†
195B42
-
22"
N/C
†
195B9
Fixed Tall (19.5")
N/C
†
195B44
-
24"
N/C
†
195B140
-
26"
N/C
(Upholstery Height Measured pan to top of upholstery.)
†
† 195B243
Adjustable Low 14" - 18"
$100.00
† 195B244
Adjustable High 20" - 26"
$100.00
Towel Bar Depth
†
195QT03
†
195QT04
Shallow (NA with Upholstery backs.)
Deep (Ext. 4" from back canes for deep
backs)
N/C
N/C
10. HEADREST OPTIONS FOR ASAP II SEAT
Available with on-chair solid backs. Headrests for Jay 3 backs need to be ordered on Jay 3 Order form.
† Whitmyer Linx Headrest Small
$450.00
† Whitmyer Linx Headrest Large
$450.00
195HE65 E0955
Plush Head Support Pad 8"
$225.00
195HE66 E0955
Plush Head Support Pad 10"
$225.00
195MH1 E1028
No Tool / Quick Rem. Headrest Mount
$225.00
195MH1 E1028
No Tool / Quick Rem. Headrest Mount
$225.00
ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com
Page 5
11. POSTURAL SUPPORTS FOR ASAP II SEAT
ALL Postural Supports are Sold as EACH; Must select both left and right for a pair.
Swing Away Lateral Thoracic Support - Left
Swing Away Knee Adductor Supports
† Swing Away Lateral Thoracic Support 4x5" - Left
195ZV09
E0956
$325.00
$225.00
$325.00
$100.00
195ZS06 E1028 Swing Away Mount
† Swing Away Lateral Thoracic Support 4x6" - Left
195ZV11 E0956 Lateral Pad Curved 4"x6"
195ZS06
E1028
Available only with Fixed and Power Center Mount Legrests.
$100.00
Lateral Pad Curved 4"x5"
Knee Adductor Supports - LEFT (choose Pad & Arm)
†
†
195KB5
195KB7
E0957
E0957
†
195XX04
E1028
Swing Away Short - Left
$225.00
†
195XX06
E1028
Swing Away Long - Left
$225.00
$170.00
$170.00
$225.00
Swing Away Mount
Swing Away Lateral Thoracic Support -Right
$395.00
Pad Size
Knee Adductor Pad SM- Left
Knee Adductor Pad LG- Left
$170.00
$170.00
S/A Arm Size
† Swing Away Lateral Thoracic Support 4x5" - Right
$325.00
195ZV10 E0956 Lateral Pad Curved 4"x5"
195ZS05 E1028 Swing Away Mount
† Swing Away Lateral Thoracic Support 4x6" - Right
$100.00
$225.00
$325.00
†
Knee Adductor Supports - RIGHT (choose Pad & Arm)
Pad Size
195KB6
E0957 Knee Adductor Pad SM- Right
†
195KB8
E0957
Knee Adductor Pad LG- Right
†
195XX05
E1028
Swing Away Short - Right
$225.00
†
195XX07
E1028
Swing Away Long - Right
$225.00
Padded Chest Strap
$225.00
195ZV12
E0956
Lateral Pad Curved 4"x6"
$100.00
195ZS05
E1028
Swing Away Mount
$225.00
Long Thigh Support w/Removable Mount
$395.00
S/A Arm Size
Available with Cantilever Arms, NA with Manual Recline Back, Dual Post, Single Post or
Cantilever w/ 2 pt Locking arms.
† SPOT Long Thigh Support - Left
†
$325.00
195TV2
E0956
Long Thigh Support - Left
$100.00
195TX1
E1028
Removable Mount - Left
$225.00
CHEST STRAP
†
195ZR03
E0960
$325.00
SPOT Long Thigh Support - Right
195TV1
E0956
Long Thigh Support - Right
$100.00
195TX2
E1028
Removable Mount - Right
$225.00
12. ARMREST AND ARMPAD OPTIONS
Armrest Mounting for K0848 Models with ASAP II
Dual Post Armrests
Armrest Mounting for K0856 SC Models with Tilt.
Dual Post Armrests
†
195EG01
Short Dual Post Flip Back 10" Height.
N/C
†
195EG09
-
Shrt Dual Post Flip Back HT Adj 10"-15"
N/C
†
195EG21
Long Dual Post Flip Back 10" Height.
N/C
†
195EG23
-
Lng Dual Post Flip Back HT Adj 10"-15"
N/C
†
195EG02
E0973
Shrt Dual Post Flip Back HT Adj 10"-15"
$230.00
†
195EG22
E0973
Lng Dual Post Flip Back HT Adj 10"-15"
$230.00
Cantilever Armrests
(Adjustable length arm pad included (choose Pad setting below, except for Low Arm
Option) NA with Manual Recline Back
†
†
195EG03
195EG04
E0973
E0973
Standard Cantilever Arm w/ 2 Point
Locking Post. (9"-10" Ht Range.) NA w/
seat depths below 16"
$230.00
Standard Cantilever Arm w/ 2 Point
Locking Post. (11"-12" Ht Range.) NA w/
seat depths below 16"
$230.00
†
195EG05
E0973
STD Cantilever Arm 9"-12" Ht Range
$230.00
†
195EG06
E0973
Low Cantilever Arm 7"-10" Ht Range
(Choose ASAPII pad type and size below)
$230.00
Cantilever Armrests
(Adjustable length arm pad included (choose Pad setting below, except for Low Arm
Option) NA with Manual Recline Back
†
195EG10
-
Standard Cantilever Arm w/ 2 Point
Locking Post. (9"-10" Ht Range.) NA w/ seat
depths below 16"
N/C
†
195EG11
-
Standard Cantilever Arm w/ 2 Point
Locking Post. (11"-12" Ht Range.) NA w/
seat depths below 16"
N/C
†
195EG12
-
STD Cantilever Arm 9"-12" Ht Range
N/C
-
Low Cantilever Arm 7"-10" Ht Range
(Choose ASAPII pad type and size below)
N/C
†
195EG13
Single Post Armrests
Single Post Armrests
†
195EG07
E0973
Single Post Height Adjustable - Std.
$230.00
†
195EG08
E0973
Single Post Height Adjustable - Low
$230.00
†
195EG14
-
Single Post Height Adjustable - Std.
N/C
†
195EG15
-
Single Post Height Adjustable - Low
N/C
-
Omit Armrest and Mounts
N/C
Omit Armrest
†
195EG20
Arm Pad Options for ASAPII
Pad Type / Size Options for Dual Post / Single Post / Low Cantilever
Left Arm Pad (N/C)
Right Arm Pad (N/C)
†
195AE01
-
Desk Length Waterfall (10")
†
195AB01
†
195AE02
-
Full Waterfall (14") NA w/Low Cant
†
195AB02
†
195AE03
-
Desk Length Standard (10")
†
195AB03
†
195AE04
-
Full Standard (14") NA w/Low Cant
†
195AB04
Pad Setting Options for Standard Cantilever Arm
Left Arm Pad (N/C)
Right Arm Pad (N/C)
†
195AE11
-
Full Length Cantilever (14")
†
195AB11
†
195AE10
-
Desk Length Cantilever (10")
†
195AB10
ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com
Page 6
13. HANGERS AND FOOTRESTS FOR ASAP II AND CAPTAIN SEAT
Hanger and Extension Tubes Options (see footplate compatibility in the brackets)
Non-Powered Swing Away Legrests
Footplate (Pair)
†
Sold as Pairs
195F1
†
195H95
65° Swing Away (A,B,C)
N/C
195F1
†
195H2
70° Swing Away (A,B,C)
N/C
195HL1
†
195H94
75° Tapered Swing Away (E)
N/C
†
195H6
90° Swing Away (B,C) (5.5-9")
N/C
†
195H138
E0990
Manual ELR S/A (A,B,C,D) (Avail. with
Fixed Centermount, choose below)
†
†
195H125
195H126
K0108
Centermount Pwr ELR w/ Articulation
(F,H)
E1010
S/A Power ELR w/ Articulation (B) Pair
(N/A for 12" or 13" wide) (Avail. with Fixed
Centermount, choose below)
$2,200.00
$2,200.00
Fixed Center Mount Legrests (includes footplate)
†
195H134
Fixed Center Mount Short
N/C
†
195H135
Fixed Center Mount Long
N/C
Adult Angle Adjustable Footplate
E0951
Heel Loop
195H144
-$20.00
Omit Hangers
†
Hanger Extensions. (See range listed in matrix below)
†
NOTE: Not all extension tube will be available; depending on the seat height, some
extension tube options may not offer enough ground clearance.
†
$210.00
$165.00
$45.00
B - Adult Angle Adjust w/Heel Loop for use with 90°
hanger (Pair)
$210.00
$165.00
195F285
K0040
Adult Angle Adjustable Footplate
195HL10
E0951
Heel Loop
$45.00
C - Kids Angle Adjust w/Leg Strap for use with 65°
and 70° hanger (Pair)
195F283
K0040
Kids Angle Adjustable Footplate
195LS13
K0038
Leg Strap
†
Omit Hangers.
$30.00
K0040
$195.00
$165.00
$30.00
C - Kids Angle Adjust w/Leg Strap for use with 90°
hanger(Pair)
$195.00
$165.00
195F286
K0040
Kids Angle Adjustable Footplate
195LS13
K0038
Leg Strap
$30.00
195F287 D - Aluminum (Pair)
†
†
N/C
Heel Loop
195F282
†
†
E0951
195HL10
†
Powered Elevating Legrests (NA Capt seat or lift)
$30.00
Composite Footplate
B - Adult Angle Adjust w/Heel Loop for use with 65°
and 70° hanger (Pair)
†
$270.00
A - Composite with Heel Loop (Pair)
$30.00
E - One Piece Angle Adjust Footplate
$195.00
195F284
K0040
One piece Angle Adjustable Footplate
195LS13
K0038
Leg Strap
$165.00
$30.00
195F288 F - Centermount single Footplate
N/C
H - Centermount High Mnt Footplate
K0037
195F290
$55.00
One piece Angle Adjustable Footplate
$55.00
195F279 Omit Footplate and extension tube
N/C
†
195E16
†
195E1
Short
N/C
†
195E2
Medium
N/C
†
1955A01
E0952
Toe Loop (Pair) Only avail on (opt B).
$45.00
†
195E5
Long
N/C
†
195LS14
K0038
Extra Leg Strap
$30.00
†
195E21
Omit Extension
N/C
K0037
High Mount Hanger
$55.00
Footrest Accessories
Lower Leg Length Matrix
(measured seat pan to the top of the footplate surface)
Footplate Matrix
Hanger Type
High Mount
Short
Medium
Long
Hanger Type
A
B
C
65° Swing Away
7-14"
13.5- 16"
16-18.5"
18-20.5"
65° Swing Away
X
X
X
70° Swing Away
7-14"
13.5- 16"
16-18.5"
18-20.5"
70° Swing Away
X
X
X
75° Tapered S/A
7-14"
13.5- 16"
14.5-19"
15-18"
75° Tapered S/A
X
X
X
X
Manual ELR S/A
12.5-17"
14.5-19"
17-21"
Manual ELR S/A
Power ELR S/A
12-14"
14-17"
16.5-19"
Power ELR S/A
Fixed Cntrmnt
12.5"-15.5"
Power Cntrmnt
13.5-18.5"
E
F
H
X
90° Swing Away
5.5-9" Footplate mounts to front of hanger.
90° Swing Away
D
X
X
X
14.5"-19.5"
Fixed Cntrmnt
X
16.5-21.5"
Power Cntrmnt
X
X
14. ACCESSORIES
Wheelchair Tray Table
Positioning Belt - Select for any style seat
†
1957A01
E0950
TRAY TABLE SM TUFFAK 12"-14" PWR
$225.00
†
195EJ01
†
1957A02
E0950
TRAY TABLE MED TUFFAK 15"-17" PWR
$225.00
†
195EJ02
E0978
Belt 2" Aircraft Buckle
$35.00
†
1957A03
E0950
TRAY TABLE LRG TUFFAK 18"-20" PWR
$225.00
†
195EJ03
E0978
Belt 2" Aircraft Buckle Padded
$65.00
Auto Style Buckle
N/C
Mounting Accessories (available with All Seats)
Backpack
Only one accessory can be mounted at a time.
†
195A1
Black Utility
$55.00
†
195A603
E2207
Cane/Crutch Holder
$250.00
†
195A2
Black/Charcoal Kids
$50.00
†
195A604
E2208
O2 holder
$250.00
†
195A605
K0108
Walker holder
$250.00
BUILT 4 ME OPTIONS
Yes! Call Customer Service
ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com
Page 7
ART SPO CUSTOM CURVED BACKREST
Posterior Positioning Backrest (E2617)
EIPW22 - Effective November 2012
Account:
Ship To:
Date:
Name:
PO#:
Address:
Buyer:
City,State,Zip:
Marked For:
Phone:
1. Backrest Type
†
SPO
E2617 CUSTOM Rectangular Back (Dia / Fig. A)
$895.00
CUSTOM 195GI01 Complete only Dimensions A & B below
Foam components similar to Diagram D
†
SPO
I-Back
E2617 I-Shape Back (Diag./ Fig. B)
$995.00
195GI02 Complete Dimensions A - E Below
Foam components similar to Diagram D
DIAGRAM A
Figure A - Custom Rectangular Back
DIAGRAM B
Figure B - I Shape Back
BACK REST TYPE DIMENSIONS
Dimension A
BACK HEIGHT
† 14
† 14.5
† 15
† 15.5
† 16
† 16.5
† 17
† 17.5
† 18
† 18.5
† 19
† 19.5
† 20
† 20.5
† 21
† 21.5
† 22
† 22.5
† 23
† 23.5
† 24
† 24.5
† 25
† 25.5
† 26
† 26.5
† 27
† 27.5
† 28
Dimension B
BACK WIDTH
Dimension C
I-BACK ONLY
(must be same as Base Width)
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†16
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†17
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†18
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†19
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†20
†3
† 3.5
†4
† 4.5
†5
† 5.5
†3
† 3.5
†3
† 3.5
†3
† 3.5
†4
†4
†4
† 4.5
†5
† 5.5
†6
†7
†7
†8
†8
†9
†9
† 10
† 10
† 11
† 11
† 3.5
†4
† 3.5
†4
† 3.5
†4
† 4.5
† 4.5
† 4.5
†5
† 5.5
†6
†7
†8
†8
†9
†9
† 10
† 10
† 11
† 11
†4
† 4.5
†4
† 4.5
†4
† 4.5
†5
†5
†5
† 5.5
†6
†7
†8
†9
†9
† 10
† 10
†5
† 4.5
†5
† 5.5
† 5.5
† 5.5
†6
†7
†8
†9
† 10
† 11
Dimension E
I-BACK ONLY
Dimension D
I-BACK ONLY
† 5.5
†5
† 5.5
†6
†6
†6
†7
†8
†5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†7 †5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†5
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†6
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†7
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†8
†9
†9
†9
†9
†9
†9
†9
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
†1
ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com
Page 8
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
† 1.5
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
†2
ART SPO CUSTOM CURVED BACKREST
Posterior Positioning Backrest (E2617)
EIPW22 - Effective November 2012
Back Relief Dimensions
2. Back Relief
†
SPO
Scapular
E2617 Scapular Cut-Out Back (Diagram C)
Complete Dimensions A, B, F & G
Foam components similar to Diagram D
$1,035.00
14-17
195GI03
Figure C - Scapular Relief Back
Diagram C - Scapular Relief Back
Dimension
A
BACK
HEIGHT
Dimension B
BACK WIDTH
Dimension F
Not Available
Not Available
†16 †17 †18 †19 †20
†4
† 18
†16 †17 †18 †19 †20
†4
†3 †4 †5 †6
† 18.5
†16 †17 †18 †19 †20
†4 †5
†3 †4 †5 †6
† 19
†16 †17 †18 †19 †20
†4 †5
†3 †4 †5 †6
† 19.5
†16 †17 †18 †19 †20
†5 †6 †8
†3 †4 †5 †6
† 20
†16 †17 †18 †19 †20
†5 †6 †8
†3 †4 †5 †6
† 20.5
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 21
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 21.5
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 22
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 22.5
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 23
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 23.5
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 24
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 24.5
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 25
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 25.5
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 26
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 26.5
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 27
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 27.5
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
† 28
†16 †17 †18 †19 †20
†6 †7 †8 †9 †3 †4 †5 †6
Custom Foam Thickness
Available on all Backs
† 2.5"
† 1.5"
† 3"
† 2"
ORDERING INFORMATION PHONE: (800) 236-4215, FAX: (602) 279-0952, WEBSITE: www.southwestmedical.com
Page 9
Not Available
† 17.5
Diagram D - Foam Components
† 1" Standard
Dimension G
(must be same as Base Width)
†3 †4 †5 †6
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