Mobility Devices Product Manual
Mobility Devices
Product Catalogue
Effective Date : 2011-Jun-13
Assistive Devices Program
Ministry of Health and Long-Term Care
Printed Date: May 3, 2011
Page: 1 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Ambulation Aids
Device Type
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Adult Wheeled Walker Type 1
Airway Surgical
Top Release 5062tr/5062tj
MW1AR0005
1
$82.00
Walker type most suitable for use on hard, flat
surfaces. ADP price includes frame, two or four
small wheels (less than 6" diameter) and
braking system (if available). See Ambulation
Aids Options Chart if heavy duty frame and/or
forearm attachments required.
Amg Medical
Deluxe Folding Wheeled Walker MW1GM0010
1
$82.00
Dana Douglas
Deluxe Regular
MW1DG0020
1
$82.00
Deluxe Small
MW1DG0025
1
$82.00
Drive Medical
One Button Or Dual Trigger
Release
MW1D50005
1
$82.00
Guardian
Easy Care G30755w &
G30756w
MW1GU0025
1
$82.00
Red Dot Extra Wide G7767
MW1GU0020
1
$82.00
Red Dot G7756 & G7810
MW1GU0035
1
$82.00
Red Dot Standard G7755 &
G7756
MW1GU0015
1
$82.00
Invacare
Adult
MW1IN0010
1
$82.00
Lumex
Dual Release Adult/Junior
MW1LU0020
1
$82.00
Lightweight Adult/Junior
MW1LU0010
1
$82.00
Rubbermaid
Deluxe
MW1C60010
1
$82.00
Adult Wheeled Walker Type 2
Airway Surgical
5314
MW2AR0010
1
$324.00
Walker type most suitable for use on hard, flat
surfaces. ADP price includes frame, four small
wheels (less than 6" diameter), hand braking
system, seat, and back support. See
Ambulation Aids Options Chart if heavy duty
frame and/or forearm attachments required.
Amg Medical
Airgo Adventure 6
MW2GM0040
1
$324.00
Airgo Ultra Light
MW2GM0050
1
$324.00
Free Spirit Iii Models 700-960 &
700-975
MW2GM0030
1
$324.00
4200 Dx
MW2DG0010
1
$324.00
4200 Lx
MW2DG0005
1
$324.00
Delta
MW2DG0035
1
$324.00
Infiniti 260
MW2DG0045
1
$324.00
Nexus 1 (Cable Brake)
MW2DG0050
1
$324.00
Duet 795b Rollator
MW2D00010
1
$324.00
Go-Lite Deluxe
MW2D50005
1
$324.00
Challenger Grande
MW2EV0025
1
$324.00
Challenger Mini
MW2EV0010
1
$324.00
Sprite & Sprite Mini
MW2EV0005
1
$324.00
Sprite Grande
MW2EV0020
1
$324.00
Rollite 65100
MW2IN0050
1
$324.00
Three Wheels
MW2IN0030
1
$324.00
Ats 902 Handi Lite
MW2NM0005
1
$324.00
Ats 903 Handi Lite
MW2NM0010
1
$324.00
Ats 904 Handi Lite
MW2NM0015
1
$324.00
Ats 907-6 Ovation
MW2NM0040
1
$324.00
Ats 908-6 Ovation
MW2NM0045
1
$324.00
Ovation Compact 807-6
MW2NM1005
1
$324.00
Dana Douglas
Drive Medical
Evolution Medical
Invacare
Nighthawk
Page: 2 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Ambulation Aids
Device Type
Adult Wheeled Walker Type 2
Manufacturer
Sunburst Medical
Walker type most suitable for use on hard, flat
surfaces. ADP price includes frame, four small
wheels (less than 6" diameter), hand braking
system, seat, and back support. See
Ambulation Aids Options Chart if heavy duty
frame and/or forearm attachments required.
Adult Wheeled Walker Type 3
Walker type most suitable for active use on
most terrains. ADP price includes frame,four
large wheels (6"/8" diameter), hand braking
system, seat, and back support. See
Ambulation Aids Options Chart if heavy duty
frame and/or forearm attachments required.
Access Vital As
Amg Medical
Dana Douglas
Dolomite
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Freedom Plus
MW22S0005
1
$324.00
Freedom Plus Short
MW22S0010
1
$324.00
Active
MW3V80005
1
$417.00
Breeze
MW3V80010
1
$417.00
Airgo Adventure 8
MW3GM0060
1
$417.00
Airgo Comfort Plus Xwd
MW3GM0055
1
$417.00
Airgo Comfort-Plus
MW3GM0050
1
$417.00
Airgo Duo
MW3GM0040
1
$417.00
Airgo Excursion
MW3GM0065
1
$417.00
Airgo Navigator
MW3GM0015
1
$417.00
Free Spirit Ergo Plus Models
700-992 & 700-997
MW3GM0020
1
$417.00
Free Spirit Ergo Plus Wide
Models 700-993 & 700-998
MW3GM0030
1
$417.00
Free Spirit Iii Models 700-990 &
700-995
MW3GM0010
1
$417.00
4200swx
MW3DG0035
1
$417.00
4200wx
MW3DG0030
1
$417.00
Excel
MW3DG0015
1
$417.00
Infiniti 280
MW3DG0025
1
$417.00
Infiniti 500
MW3DG0020
1
$417.00
Nexus Ii (Cable Brake)
MW3DG0040
1
$417.00
Nexus Iii (Cable Free Braking
System)
MW3DG0045
1
$417.00
Riva
MW3DG0005
1
$417.00
Solo
MW3DG0010
1
$417.00
Alpha Advanced
MW3DO1085
1
$417.00
Alpha Basic
MW3DO1080
1
$417.00
Jazz
MW3DO2000
1
$417.00
Legacy Lite
MW3DO0100
1
$417.00
Melody
MW3DO1090
1
$417.00
Opal Futura Symphony
MW3DO1055
1
$417.00
Opal Legacy
MW3DO1040
1
$417.00
Opal Maxi / Maxi+
MW3DO1035
1
$417.00
Soprano
MW3DO1095
1
$417.00
Drive Medical
Diamond 740r Rollator
MW3D50010
1
$417.00
Enkatsu Solutions
Prima Rollator
MW3EH0005
1
$417.00
Page: 3 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Ambulation Aids
Device Type
Adult Wheeled Walker Type 3
Manufacturer
Evolution Medical
Walker type most suitable for active use on
most terrains. ADP price includes frame,four
large wheels (6"/8" diameter), hand braking
system, seat, and back support. See
Ambulation Aids Options Chart if heavy duty
frame and/or forearm attachments required.
Nighthawk
Sunburst Medical
Topro
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Challenger Low Wide
MW3EV0035
1
$417.00
Challenger Wide
MW3EV0030
1
$417.00
Evolution Dx, Ldx, Wdx, Lwdx
MW3EV0005
1
$417.00
Horizon Dx, Wdx, Lwdx, Tdx
MW3EV0010
1
$417.00
Piper Dx, Mdx, Smdx, Tdx
MW3EV0020
1
$417.00
Xpresso, Xpresso Lite
MW3EV0040
1
$417.00
Ats 906 0vation
MW3NM0015
1
$417.00
Ats 907 Ovation
MW3NM0020
1
$417.00
Ovation Compact 805-8
MW3NM1005
1
$417.00
Ovation Compact 806-8
MW3NM1010
1
$417.00
Freedom All Terrain
MW32S0010
1
$417.00
Freedom Xl
MW32S0015
1
$417.00
Freedom Xls
MW32S0005
1
$417.00
Mirage 4900
MW32S0030
1
$417.00
Mirage 4925
MW32S0040
1
$417.00
Mirage 4950
MW32S0035
1
$417.00
Shopper 4700
MW32S0020
1
$417.00
Titan
MW32S0050
1
$417.00
Olympos
MW3TV0020
1
$417.00
Troja
MW3TV0010
1
$417.00
Approved ADP
Manufacturers Only
Forearm Crutches
MKZND0005
1
$121.00
Paediatric Specific Walking Frame
Alvema
Hopla
MW6AL0005
1
$2,578.00
ADP price includes frame, four wheels, hand
grips (including arm supports), and built in
sitting support (e.g. sling/saddle seat). See
Ambulation Aids Options Chart for adolescent
sizes.
Can-Dan Rehatec
Meywalk Mk3, Medium & Large
MW6CD0045
1
$2,578.00
Meywalk, Medium & Large
MW6CD0040
1
$2,578.00
Forearm Crutches
1 Pair of Forearm Crutches from the following
manufacturers may be billed under this code.
Mini-Meywalk
MW6CD0050
1
$2,578.00
Kids Up Inc
Flux Gait Trainer
MW6K20005
1
$2,578.00
Ormesa
Grillo
MW6OA0005
1
$2,578.00
Prime Engineering
Kidwalk
MW62P0005
1
$2,578.00
Rifton Equipment
Pacer Gait Trainer
MW6RF0005
1
$2,578.00
Sos Rehab
Bronco,Sizes 0,1,2
MW6R80060
1
$2,578.00
Crocodile Reverse Walker
MW6R80070
1
$2,578.00
Dynamico
MW6R80055
1
$2,578.00
Gator
MW6R80005
1
$2,578.00
Pony,Size 0
MW6R80040
1
$2,578.00
Pony,Size 1
MW6R80045
1
$2,578.00
Pony,Size 2
MW6R80050
1
$2,578.00
Pony,Size 3
MW6R80052
1
$2,578.00
Page: 4 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Ambulation Aids
Device Type
Paediatric Specific Wheeled Walker
Type 1
Manufacturer
Guardian
Walker type most suitable for use on hard, flat
surfaces. ADP price includes frame, two or four
small wheels, and braking system (if available).
See Ambulation Aids Options Chart for
adolescent sizes.
Kaye
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Strider Middler G-7781
MW4GU0025
1
$220.00
Strider Regular G-7780
MW4GU0020
1
$220.00
Strider Tweener G-7783
MW4GU0035
1
$220.00
Strider Tyke G-7782
MW4GU0030
1
$220.00
Tyke G-7751
MW4GU0010
1
$220.00
Adolescent 2 Wheels
MW4KY0065
1
$220.00
Adolescent 4 Wheels
MW4KY0070
1
$220.00
Adolescent 4 Wheels/Swivel
MW4KY0075
1
$220.00
Child 2 Wheels
MW4KY0020
1
$220.00
Child 4 Wheels
MW4KY0025
1
$220.00
Child 4 Wheels/Swivel
MW4KY0030
1
$220.00
Child Small 2 Wheels
MW4KY0005
1
$220.00
Child Small 4 Wheels
MW4KY0010
1
$220.00
Child Small 4 Wheels/Swivel
MW4KY0015
1
$220.00
Pre-Adolescent 2 Wheels
MW4KY0050
1
$220.00
Pre-Adolescent 4 Wheels
MW4KY0055
1
$220.00
Pre-Adolescent 4
Wheels/Swivel
MW4KY0060
1
$220.00
Youth 2 Wheels
MW4KY0035
1
$220.00
Youth 4 Wheels
MW4KY0040
1
$220.00
Youth 4 Wheels/Swivel
MW4KY0045
1
$220.00
Otto Bock
Nurmi Neo
MW5OB0005
1
$1,524.00
Paediatric Standing Frame Type 1
I.D.C.Tectonics Ltd.
Prone Stander 130c
MS1HM0005
1
$1,219.00
ADP price includes frame, positioning straps,
trunk, pelvic, knee and foot supports, and tray.
See Ambulation Aids Options Chart for
adolescent sizes.
Prime Engineering
Up-Right Stander
MS12P0015
1
$1,219.00
Vasi
Vertical Stander
MS1HY0005
1
$1,219.00
Paediatric Standing Frame Type 2
Altimate Medical
Easy Stand 5000&7000
Magician
MS2HC0005
1
$3,285.00
Easy Stand Bantam
MS2HC0015
1
$3,285.00
Easy Stand Evolv
MS2HC0010
1
$3,285.00
Dondolino, Size 1
MS2OA0010
1
$3,285.00
Dondolino, Size 2
MS2OA0015
1
$3,285.00
Dondolino, Size 3
MS2OA0020
1
$3,285.00
Mini Standy
MS2OA0030
1
$3,285.00
Standy
MS2OA0035
1
$3,285.00
Kidstand & Grandstand 111
MS22P0010
1
$3,285.00
Superstand,Small & Youth
MS22P0005
1
$3,285.00
Paediatric Specific Wheeled Walker
Type 2
Walker type most suitable for active use on
most terrains. ADP price includes all
components and options.
ADP price includes frame, positioning straps,
trunk, pelvic, knee and foot supports, and tray.
See Ambulation Aids Options Chart for
adolescent sizes.
Ormesa
Prime Engineering
Page: 5 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Ambulation Aids
Device Type
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Paediatric Standing Frame Type 2
Prime Engineering
Symmetry Standing Frame
MS22P0015
1
$3,285.00
ADP price includes frame, positioning straps,
trunk, pelvic, knee and foot supports, and tray.
See Ambulation Aids Options Chart for
adolescent sizes.
Prodije
Baby,Kid & Junior
MS2JP0010
1
$3,285.00
Sos Rehab
Buffalo,Size 1
MS2R80005
1
$3,285.00
Buffalo,Size 2
MS2R80010
1
$3,285.00
Buffalo,Size 3
MS2R80015
1
$3,285.00
Gazelle,Size 1
MS2R80020
1
$3,285.00
Gazelle,Size 2
MS2R80025
1
$3,285.00
Gazelle,Size 3
MS2R80030
1
$3,285.00
Giraffe
MS2SG0005
1
$3,285.00
Page: 6 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Ambulation Aids
OPTIONS:
Device Type
AA - Custom Modifications
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
MOCM
1
AA5
1
$100.00
AA7
1
$300.00
AA6
1
$200.00
AA8
1
$100.00
AA1
2
$200.00
AA2
1
$100.00
The MOCM code may be used when custom
modifications are required to an ADP listed
ambulation aid or paediatric stander, and there
is no ADP code with assigned funding
available. The following documentation must be
submitted: 1. Authorizer must provide clinical
rationale to support the request. 2. Vendor must
provide a breakdown of the cost of labour (not
to exceed $40.00/hour), and parts.
Adolescent Size Paediatric Specific
Walker
ADDITIONAL FUNDING FOR ADOLESCENT
SIZED PAEDIATRIC WALKERS (DEVICE
TYPE MW4 & MW5). AUTHORIZER MUST
DOCUMENT CLINICAL REQUIREMENTS.
SELECTED DEVICE MUST MEET SIZE
REQUIREMENTS.
Adolescent Size Paediatric Standing
Frame
ADDITIONAL FUNDING FOR ADOLESCENT
SIZED PAEDIATRIC STANDING FRAMES
(DEVICE TYPE MS1 & MS2). AUTHORIZER
MUST DOCUMENT CLINICAL
REQUIREMENTS. SELECTED DEVICE MUST
MEET SIZE REQUIREMENTS.
Adolescent Size Paediatric Walking
Frame
ADDITIONAL FUNDING FOR ADOLESCENT
SIZED PAEDIATRIC WALKING FRAMES
(DEVICE TYPE MW6). AUTHORIZER MUST
DOCUMENT CLINICAL REQUIREMENTS.
SELECTED DEVICE MUST MEET SIZE
REQUIREMENTS.
Extra Wide Adult Wheeled Walker
EXTRA WIDE ADULT WHEELED WALKER
(GREATER THAN 18" BETWEEN PUSH
HANDLES) DUE TO CLIENT STATURE.
CLIENT WEIGHT LESS THAN 275LBS.
AUTHORIZER MUST DOCUMENT CLIENT'S
REQUIREMENTS.
Forearm Attachments
FOREARM ATTACHMENTS FOR WHEELED
WALKERS. AUTHORIZER MUST PROVIDE
CLINICAL RATIONALE TO SUPPORT
REQUEST (MAXIMUM 2).
Heavy Duty Package Client Weight
275-350 lbs
HEAVY DUTY PACKAGE FOR WHEELED
WALKERS, CLIENT WEIGHT 275-350 LBS.
AUTHORIZER MUST DOCUMENT CLIENT
WEIGHT. SELECTED DEVICE MUST MEET
WEIGHT REQUIREMENTS.
Page: 7 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Ambulation Aids
OPTIONS:
Device Type
Heavy Duty Package Client Weight
350-400 lbs
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
AA3
1
$150.00
AA4
1
$200.00
AA9
1
$100.00
HEAVY DUTY PACKAGE FOR WHEELED
WALKERS, CLIENT WEIGHT 350-400 LBS.
AUTHORIZER MUST DOCUMENT CLIENT
WEIGHT. SELECTED DEVICE MUST MEET
WEIGHT REQUIREMENTS.
Heavy Duty Package Client Weight
Exceeded 400 lbs
HEAVY DUTY PACKAGE FOR WHEELED
WALKERS, CLIENT WEIGHT EXCEEDS
400LBS. AUTHORIZER MUST DOCUMENT
CLIENT WEIGHT. SELECTED DEVICE MUST
MEET WEIGHT REQUIREMENTS.
Unilateral Hand Brake
UNILATERAL HAND BRAKE. ALLOWS
LOCKING/BRAKING OF BOTH BRAKES
USING ONE HAND. AUTHORIZOR MUST
DOCUMENT CLINICAL REQUIREMENTS.
(MAX 1)
Page: 8 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Action
Products
Adaptive
Engineering
Lab
Adaptive
Equipment
Systems
(Aes)
Device
ADP Code
Max
Allowed
Qty.
Twister Cb Back 15"-16" Width X
11"-16" Height
SEBAN0005
1
$450.00
Twister Cb Back 15"-16" Width X
17"-21" Height
SEBAN0025
1
$450.00
Twister Cb Back 17"-18" Width X
11"-16" Height
SEBAN0010
1
$450.00
Twister Cb Back 17"-18" Width X
17"-21" Height
SEBAN0030
1
$450.00
Twister Cb Back 19"-20" Width X
11"-16" Height
SEBAN0015
1
$530.00
Twister Cb Back 19"-20" Width X
17"-21" Height
SEBAN0035
1
$530.00
Twister Cb Back 21"-23" Width X
11"-16" Height
SEBAN0020
1
$530.00
Twister Cb Back 21"-23" Width X
17"-21" Height
SEBAN0040
1
$530.00
Drop-In R-Back Curved With 1.5" Poly
Foam
SEBE10030
1
$223.00
Drop-In R-Back Curved With Sun-Mate
Or Pudgee Foam
SEBE10035
1
$233.00
Drop-In R-Back Curved With Sun-Mate
Or Pudgee Foam
SEBE10040
1
$267.00
Drop-In R-Back With 1" Poly Foam
SEBE10005
1
$177.00
Drop-In R-Back With 1.5" Poly Foam
SEBE10010
1
$195.00
Drop-In R-Back With Sun-Mate Or
Pudgee Foam
SEBE10020
1
$195.00
Drop-In T-Back Curved With Sun-Mate
Or Pudgee Foam
SEBE10075
1
$289.00
Drop-In T-Back Curved With Sun-Mate
Or Pudgee Foam
SEBE10080
1
$254.00
Drop-In T-Back With Sun-Mate Or
Pudgee Foam
SEBE10060
1
$251.00
Adjustable Bi-Angular Solid Back Insert, SEB2L1025
Includes T-Nuts
& Adjustment Brackets.
1
$438.00
Back Supports Hardware Not Included
Solid Back Insert, Includes T-Nuts.
SEB2L1005
1
$183.00
Back Supports Including Upper & Lower SEB2L0005
Back Mounting Hardware Solid Back
Insert Package W/Universal Hardware
Or E-Z Mount
Mount Hardware & Rotating Hold
Downs.
1
$643.00
I Or T Or Curved Syle Solid Back Insert, SEB2L1015
Includes T-Nuts.
1
$274.00
Oversize Upcharge For Backs Over 2o"
But Less Than 28".
1
$80.00
SEB2L1040
ADP
Approved
Amt.
Page: 9 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Adaptive
Equipment
Systems
(Aes)
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Quick-Fit Contour/Bi-Angular Solid
Back Insert,
Incudes T-Nuts.
SEB2L1030
1
$602.00
Sculptured Solid Back Insert, Includes
T-Nuts.
SEB2L1035
1
$999.00
Sculpturefit Back W/Attaching
Hardware, Custom.
SEB2L0015
1
$1,236.00
Solid Back Insert Package, Li'L Kiddos,
14" Wide Or Less.
SEB2L0020
1
$733.00
Solid Back Insert Package, Li'L Kiddos,
Contoured, 14" Wide.
SEB2L0025
1
$898.00
Solid Back Insert, Includes T-Nuts, Li'L
Kiddos,
14" Wide Or Less.
SEB2L1010
1
$247.00
Solid Back W/Drop Hooks & Fixed Hold
Downs.
SEB2L0010
1
$267.00
Contoured Back
SEBAO0040
1
$300.00
Deep "U" Back
SEBAO0035
1
$340.00
Ez Back Basic
SEBAO0060
1
$352.00
Ez Back System Complete
SEBAO0055
1
$411.00
Pro Back Support
SEBAO0065
1
$520.00
U Form Deep Contour Back Support
SEBAO0050
1
$863.00
Contour Back Support For Heavy Duty
SEB4P0020
1
$956.00
Contour Back Support, Non-Standard
Sizes
SEB4P0015
1
$607.00
Contour Back Support, Standard Sizes
SEB4P0010
1
$513.00
Broda
Back Pad
SEBB-0010
1
$67.00
Custom
Fabricated
Back With Permanent Lateral Supports,
Vinyl Cover,
Without Mounting Hardware
SEBCF114L
1
$650.00
Complex Indirect Molded Back,
Without Cover And Mounting Hardware
SEBCF118L
1
$1,460.00
Complex Molded Back (Foam In Place), SEBCF117L
Without Cover And Mounting Hardware
1
$1,301.00
Contoured Back (Foam On Rigid Base), SEBCF112L
Minimal Trunk Support,
Vinyl Cover, Without Mounting
Hardware
1
$500.00
Custom Contoured Back, Moderate
Trunk Support,
Vinyl Cover, Without Mounting
Hardware
SEBCF113L
1
$780.00
Custom Shaped Sculptured Back,
Includes Cover,
Without Mounting Hardware
SEBCF115L
1
$950.00
Advanced
Mobility
Amysystems
Page: 10 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Custom
Fabricated
Dynamic
Health Care
Solutions
Future
Mobility
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Flat Back/Planar Design, Vinyl Cover
Without Mounting Hardware
SEBCF110L
1
$300.00
Simple Molded Back (Foam In Place),
Without Cover And Mounting Hardware
SEBCF116L
1
$939.00
Nxt Act Back Cushion Sizes 14' - 21"
SEBD30010
1
$575.00
Nxt Pc Back Cushion Sizes 14" - 21"
SEBD30015
1
$671.00
Nxt Sc Back Cushion Sizes 14" - 21"
SEBD30005
1
$551.00
Full Back - Sizes From 14" To 22" Lateral
SEBFM3040
1
$636.00
Full Back - Sizes From 14" To 22" Ultra Lateral
SEBFM3050
1
$684.00
Full Back - Sizes From 18" To 24" No
Lateral
SEBFM3020
1
$588.00
Full Back Style Heaby Duty
SEBFM3060
1
$840.00
Low Back - Sizes From 14" To 22" Lateral
SEBFM3035
1
$560.00
Lunar Back Low Back - Sizes From 16"
To 20" - No Lateral
SEBFM3010
1
$500.00
Mid Back - Sizes From 14" To 22" Lateral
SEBFM3030
1
$616.00
Mid Back - Sizes From 14" To 22" Ultra Lateral
SEBFM3045
1
$664.00
Mid Back - Sizes From 16" To 20" - No
Lateral
SEBFM3015
1
$568.00
Mid Back Style Heavy Duty
SEBFM3055
1
$800.00
Orion Back
SEBFM3005
1
$464.00
Prism Air Back - Custom Sizes
SEBFM0045
1
$860.00
Prism Air Back - Non Standard Sizes
SEBFM0040
1
$760.00
Prism Air Back Fits 16,18,20" Wide
W/C
SEBFM0035
1
$640.00
Prism Bariatric Air Back 21x16 Though
24x20
SEBFM2025
1
$960.00
Prism Bariatric Air Back- Custom Size
SEBFM2030
1
$1,060.00
Prism Bariatric Backs Prism Bariatric
Basic Back 21x16 Through 42x20
SEBFM2005
1
$800.00
Prism Bariatric Basic Back - Custom
Size
SEBFM2010
1
$860.00
Prism Bariatric Ultra Back 21x16
Through 24x20
SEBFM2015
1
$808.00
Prism Bariatric Ultra Back- Custom Size SEBFM2020
1
$920.00
Prism Basic Back - Custom Sizes
SEBFM0015
1
$660.00
Prism Basic Back - Non Standard Sizes
SEBFM0010
1
$600.00
Prism Basic Back Fits 16,18,20" Wide
W/C
SEBFM0005
1
$492.00
Page: 11 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Future
Mobility
Handicare
Innovators
1993 Inc
Invacare
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Prism Max Back Prism Max Back Upcharge
SEBFM0150
1
$100.00
Prism Phantom Back 12-18" Width X 7"
Height
SEBFM0070
1
$319.00
Prism Super Back For Kids - Custom
Sizes
SEBFM0090
1
$660.00
Prism Super Back For Kids - Non
Standard Sizes
SEBFM0085
1
$572.00
Prism Super Back For Kids Fits 10, 12,
14 And 16" Wide W/C
SEBFM0080
1
$500.00
Prism Truefitt Back - Bariatric Sizes
SEBFM0060
1
$1,000.00
Prism Truefitt Back - Custom Sizes
SEBFM0065
1
$820.00
Prism Truefitt Back - Non Standard
Sizes
SEBFM0055
1
$740.00
Prism Truefitt Back Fits 16,18,20" Wide
W/C
SEBFM0050
1
$700.00
Prism Ultra Back - Custom Sizes
SEBFM0030
1
$808.00
Prism Ultra Back - Non Standard Sizes
SEBFM0025
1
$720.00
Prism Ultra Back Fits 16,18,20" Wide
W/C
SEBFM0020
1
$620.00
Backrest "Plush", Deep Or Active
Contour
SEBM90020
1
$532.00
Emineo Manual Wheelchair Smartsit
Comfort Back - All Sizes
SEBM90100
1
$636.00
Ibis Manual Wheelchair Back Cushion
16x20,18x20
SEBM90005
1
$196.00
Lateral Support Backrest 16x20,18x20
SEBM90010
1
$344.00
Custom Contour Back
SEBI30070
1
$320.00
K Special Back-Custom
SEBI30020
1
$176.00
K Special Back-Standard
SEBI30010
1
$151.00
K-Combo Back
SEBI30060
1
$200.00
K-Combo Back Custom
SEBI30065
1
$222.00
Key-Hole Back
SEBI30030
1
$176.00
Key-Hole Back Custom
SEBI30040
1
$196.00
Key-Hole Back Custom Adjustable Top
SEBI30045
1
$196.00
Bariatric Builder Size
SEBNS0058
1
$762.00
Contour U Backs Includes All
Modifications & Vacuum/Vinyl
Upholstery
SEBNS1030
1
$1,340.00
Curved Backs Fits 10" To 20" Wide
W/C
SEBNS0030
1
$501.00
Dualflex 10 Max Contour, Fits 14" To
16" Wide W/C
SEBNS4050
1
$769.00
Page: 12 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Invacare
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Dualflex 10 Max Contour, Fits 17" To
19" Wide W/C
SEBNS4055
1
$769.00
Dualflex 10 Max Contour, Fits 20" To
22" Wide W/C
SEBNS4060
1
$814.00
Dualflex 10 Mild Contour, Fits 14" To
16" Wide W/C
SEBNS4005
1
$698.00
Dualflex 10 Mild Contour, Fits 17" To
19" Wide W/C
SEBNS4010
1
$698.00
Dualflex 10 Mild Contour, Fits 20" To
22" Wide W/C
SEBNS4015
1
$743.00
Dualflex 10 Mixed Contour, Fits 14" To
16" Wide W/C
SEBNS4095
1
$769.00
Dualflex 10 Mixed Contour, Fits 17" To
19" Wide W/C
SEBNS4105
1
$769.00
Dualflex 10 Mixed Contour, Fits 20" To
22" Wide W/C
SEBNS4110
1
$814.00
Dualflex 10 Short Max Contour, Fits 14"
To 16" Wide W/C
SEBNS4065
1
$769.00
Dualflex 10 Short Max Contour, Fits 17"
To 19" Wide W/C
SEBNS4070
1
$769.00
Dualflex 10 Short Max Contour, Fits 20"
To 22" Wide W/C
SEBNS4075
1
$814.00
Dualflex 10 Short Mild Contour, Fits 14"
To 16" Wide W/C
SEBNS4020
1
$698.00
Dualflex 10 Short Mild Contour, Fits 17"
To 19" Wide W/C
SEBNS4025
1
$698.00
Dualflex 10 Short Mild Contour, Fits 20"
To 22" Wide W/C
SEBNS4030
1
$743.00
Dualflex 10 Short Mixed Contour, Fits
14" To 16" Wide W/C
SEBNS4115
1
$769.00
Dualflex 10 Short Mixed Contour, Fits
17" To 19" Wide W/C
SEBNS4120
1
$769.00
Dualflex 10 Short Mixed Contour, Fits
20" To 22" Wide W/C
SEBNS4125
1
$814.00
Dualflex 10 Tall Max Contour, Fits 14"
To 16" Wide W/C
SEBNS4080
1
$858.00
Dualflex 10 Tall Max Contour, Fits 17"
To 19" Wide W/C
SEBNS4085
1
$858.00
Dualflex 10 Tall Max Contour, Fits 20"
To 22" Wide W/C
SEBNS4090
1
$902.00
Dualflex 10 Tall Mild Contour, Fits 14"
To 16" Wide W/C
SEBNS4035
1
$787.00
Dualflex 10 Tall Mild Contour, Fits 17"
To 19" Wide W/C
SEBNS4040
1
$787.00
Dualflex 10 Tall Mild Contour, Fits 20"
To 22" Wide W/C
SEBNS4045
1
$832.00
Page: 13 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Invacare
Jay Medical
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Dualflex 10 Tall Mixed Contour, Fits 14"
To 16" Wide W/C
SEBNS4130
1
$858.00
Dualflex 10 Tall Mixed Contour, Fits 17"
To 19" Wide W/C
SEBNS4135
1
$858.00
Dualflex 10 Tall Mixed Contour, Fits 20"
To 22" Wide W/C
SEBNS4140
1
$902.00
Naked Contour U Back, Includes All
Modifications
& Vacuum/Moisture Proof
Coating/Removable Cover
& Cover Pattern.
SEBNS1035
1
$1,594.00
Personal Back 10 Fits 16", 18", 20"
Wide W/C
SEBNS0052
1
$515.00
Plus - Bariatric Builder Size
SEBNS0088
1
$894.00
Plus - Fits 16", 18", 20" Wide W/C
SEBNS0062
1
$647.00
Pneumatic Fits 10" To 20" Wide W/C
SEBNS0040
1
$550.00
Pneumatic Special Size & Modifications
SEBNS0045
1
$652.00
Silouette Back Support
SEBNS1020
1
$632.00
Special Size
SEBNS0057
1
$515.00
Special Size & Modifications
SEBNS0035
1
$602.00
Special Size Modular Plus
SEBNS0067
1
$647.00
18"-14" Rigid Mount
SEBJA1015
1
$391.00
18"/16" Tall Quick Release Mount
SEBJA1012
1
$459.00
20" Tall
SEBJA1014
1
$538.00
20-23", 23-26" Back Assembly For 0 To
8 Degree Backposts,
With Headrest Mounting Kit
SEBJA0310
1
$1,220.00
Adjustable Aluminum Shell 20"
SEBJA3002
1
$742.00
Adjustable Contour Back For 14" Or 16" SEBJA4010
Frame Width,
Various Back Heights
1
$380.00
Adjustable Contour Back For 18" Frame SEBJA4015
Width,
Various Back Heights
1
$424.00
Custom Contoured Insert 20"
SEBJA3055
1
$806.00
Encompass Back Encompass Back
SEBJA8200
1
$360.00
Foam Back
SEBJA5040
1
$115.00
Focus Point Back Focus Point Back, All
Sizes
SEBJA8100
1
$626.00
Includes Mounting Hardware ("K" Or
"G" Type),
Cover & Lumbar Supports (20")
SEBJA0110
1
$649.00
Includes Mounting Hardware, Cover
& Lumbar Supports (12"/13")
SEBJA0105
1
$581.00
Page: 14 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Jay Medical
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
J2 Back Includes Mounting Hardware
("K" Or "G" Type),
Cover & Lumbar Supports (14"-19")
SEBJA0100
1
$581.00
J2 Deep Contour Back 20wx20h,
Includes Mounting
Hardware, Cover, Lumbar Supports &
Lateral Wedges
SEBJA7005
1
$646.00
J2 Deep Contour Back J2 Deep
Contour Back 14w-19w, Includes
Mounting
Hardware, Cover, Lumbar Supports &
Lateral Wedges
SEBJA7000
1
$606.00
J2 Plus Back 20-23", 23-26" J2 Back
Assembly
For 0 Or 8 Degree Backposts
SEBJA0300
1
$1,138.00
J3 Back J3 Lower Thoracic Back, All
Sizes
SEBJA0900
1
$440.00
J3 Mid Thoracic Back, All Sizes
SEBJA0905
1
$592.00
J3 Shoulder Height Back, All Sizes
SEBJA0915
1
$716.00
J3 Upper Thoracic Back, All Sizes
SEBJA0910
1
$696.00
Jay 3 Heavy Duty Sizes 12 Height To
26 Width
Sizes 15 Height To 26 Width
SEBJA8205
1
$1,220.00
Jay 3 Heavy Duty Sizes 18 Height To
24 Width
SEBJA8210
1
$1,300.00
Jay 3 Heavy Duty Sizes 21 Height To
22 Width
SEBJA8215
1
$1,416.00
Jay Active Back 18"-14" Quick Release
Mount
SEBJA1010
1
$422.00
Jay Active Back With Permanent Mount
(Large)
SEBJA1019
1
$501.00
Jay Basic Back Jay Basic Back, Fixed
Strap Style, All Sizes
SEBJA2020
1
$373.00
Jay Basic Back, Fixed Clamp Style, All
Sizes
SEBJA2025
1
$406.00
Jay Care Back 19-20" Plus Width
SEBJA5010
1
$611.00
Jay Care Back Foam Large Size
SEBJA5045
1
$158.00
Jay Care Back Jay Care Back 15-18"
Wide
SEBJA5000
1
$510.00
Jay Care Back Shell Large Size
SEBJA5055
1
$327.00
Jay Fit Back Adjustable Contour Back
For 10" Or 12" Frame Width,
Various Back Heights
SEBJA4005
1
$336.00
Jay Modular Back Adjustable Aluminum
Shell (18",16",14")
SEBJA3000
1
$640.00
Jay Modular Back Custom Contoured
Insert 18"/16"/14"
SEBJA3050
1
$698.00
Page: 15 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Jay Medical
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Jay Precision Back Precision Back
SEBJA8005
1
$683.00
Standard Insert 18"/16"/14"
SEBJA3005
1
$416.00
Standard Insert 20"
SEBJA3010
1
$544.00
Tall Back Includes Mounting Hardware,
Cover
& Lumbar Supports (14"/16"/17"/18")
SEBJA0120
1
$666.00
Tall Back Includes Mounting Hardware,
Cover
& Lumbar Supports (20")
SEBJA0130
1
$768.00
Xtreme Xtreme Back Fits 13" To 18"
Wide W/C
SEBJA6005
1
$424.00
I-Back Cushion Tlc
SEBKT2015
1
$117.00
Xpress T-Back 1" Short, Regular, Or
Tall
SEBKT2025
1
$130.00
Xpress T-Back 2.5" Short, Regular, Or
Tall
SEBKT2030
1
$130.00
Adjustable Height Back System
SEBK20060
1
$340.00
Back Cushion - All Sizes
SEBK20005
1
$300.00
Xps Adaptive Back Cushion
SEBK20050
1
$300.00
Lpa Medical
Inc.
Adjustable Tension Back
SEBO12010
1
$199.95
Contour Back Cushion
SEBO12005
1
$108.00
Maple Leaf
Power Plus
Contour Padded Personal Back
SEBWM0005
1
$288.00
Deep U Back Custom Sizes
SEBWM0015
1
$720.00
Deep U Deep U Back Standard Sizes
SEBWM0010
1
$608.00
Kyphotic Tension Kyphotic Tension
Back Rest - Shallow Or Deep U
SEBWM0030
1
$832.00
Mid U Back Mid U Back Standard Sizes
SEBWM0027
1
$700.00
Shallow U Back Custom Sizes
SEBWM0025
1
$608.00
Shallow U Shallow U Back Standard
Sizes
SEBWM0020
1
$544.00
Shape U Back Shape U Back Standard
Sizes
SEBWM0026
1
$820.00
Upcharge For Custom Height
SEBWM0040
1
$176.00
Upcharge For Custom Width
SEBWM0035
1
$176.00
All Sizes Pb Elite Deep Back
SEB1M0026
1
$716.00
Deep Heavy Duty Posture Back, All
Sizes
SEB1M0020
1
$1,069.00
Deep Posture Back, All Sizes
SEB1M0015
1
$789.00
Extra Wide Deep Heavy Duty Backs
From 16 To 20 Inches
SEB1M0040
1
$1,437.00
Genera Back Genera Back
SEB1M0050
1
$443.00
Heavy Duty Posture Back Fits W/C
20"-25" Width & 16"-20" Height
SEB1M0010
1
$929.00
Kid Kart
Kids Up Inc
Matrx Seating
Page: 16 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Matrx Seating
Motion
Concepts
Nighthawk
Orthofab
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Matrx High Back High Back Fits W/C
16" - 21" Width & 20" - 30" Height
SEB1M1005
1
$649.00
Matrx Posture Backs Extra Wide Heavy
Duty Backs Sizes 16 To 20 Inches
SEB1M0035
1
$1,314.00
Matrxpb Posture Backs Posture Back
Fits W/C 13"-20" Width & 12"-20"Height
SEB1M0005
1
$649.00
Posture Back Elite Ls, All Sizes
SEB1M0030
1
$677.00
Posture Back Elite, Posture Back Elite
Full Back, All Sizes
SEB1M0025
1
$677.00
Trx Rehab Back Rehab Back, Fits W/C
18" - 25" Width
SEB1M1050
1
$236.00
Trx Contour Back, For Trx Systems, 16,
18, 22" Wide
Wheelchairs, Height Adjustable 18-26"
SEBZG0005
1
$275.00
Trx Onyx Contour Back & Trx Single
Post Cloth Contour Back,
For Trx Systems
SEBZG0020
1
$369.00
Trx Single Post Onyx Contour Back For
Trx Systems
SEBZG0025
1
$369.00
Key-Hole Back
SEBNM0050
1
$228.00
Relaxed Back High
SEBNM0010
1
$184.00
Relaxed Back High With Flap
SEBNM0020
1
$195.00
Relaxed Back Low
SEBNM0005
1
$184.00
Relaxed Back Low With Flap
SEBNM0015
1
$195.00
"G" Back Mild Contour 14-20" Width &
16,18,20" Height
SEBOF1025
1
$520.00
"G" Mild Contour Non Standard Sizes &
Options
SEBOF1030
1
$576.00
"K" For Kyphosis Deep Contour 15-18"
Width & 16,18" Height
SEBOF1015
1
$520.00
"K" For Kyphosis Deep Contour Non
Standard Sizes
& Options
SEBOF1020
1
$400.00
Apex Backs Modular Mild Or Deep
Contour 14-20" Width & 16,18,20"
Height
SEBOF1005
1
$520.00
Harmoni Backs High Profile Contoured
14-20"Width, 16-20" Height
SEBOF2005
1
$426.00
High Profile Contoured Non Standard
Sizes
SEBOF2010
1
$472.00
High Profile Tall Contoured 14-20"
Width, 18-22" Height
SEBOF2015
1
$400.00
High Profile Tall Contoured Non
Standard Sizes & Options
SEBOF2020
1
$472.00
Low Profile Contoured 14-20" Width,
16-20" Height
SEBOF2025
1
$400.00
Page: 17 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Orthofab
Otto Bock
Performance
Health
Products
Permobil
Device
ADP Code
Max
Allowed
Qty.
Low Profile Contoured Non Standard
Sizes
SEBOF2030
1
$472.00
Modular Mild Or Deep Contour Non
Standard Sizes
SEBOF1010
1
$576.00
Back System 2, 15" To 17" & 18" To
20"
SEBOB9600
1
$508.00
Back System 3, 15" To 17" & 18" To
20"
SEBOB9605
1
$606.00
Back System 4, 15" - 20" Sizes
SEBOB9610
1
$793.00
Back-Itemized Cushion (Unfinished)
SEBOB9655
1
$1,453.00
Procontour Backs Back System 1, 15"
To 17" & 18" To 20"
SEBOB9555
1
$397.00
Procontour Custom (Obss) BackFinished With Spray
Coating,Cover,Sewing Pattern
SEBOB9650
1
$1,983.00
V-Trak Ax-Sb Back Support Connisting
Of 1 Insert, All Sizes
SEBP00015
1
$644.00
V-Trak Ax-Sb Back Support Consisting
Of 2 Inserts, All Sizes
SEBP00020
1
$1,016.00
V-Trak Ax-Sb Back Support Consisting
Of 3 Inserts, All Sizes
SEBP00025
1
$1,336.00
V-Trak Axh Back Support, All Sizes
SEBP00010
1
$872.00
V-Trak Axs Back Support, All Sizes
SEBP00005
1
$780.00
Ergo Back - Fixed - All Sizes
SEB1P0005
1
$802.00
Ergo Back - Recline - All Sizes
SEB1P0010
1
$802.00
Rectangular Back - All Sizes
SEB1P0015
1
$1,220.00
SEBWB0010
1
$1,711.00
Back Vacuum Formed, Includes Labour
For Digitizing Or
Plastering
SEBWB0005
1
$1,439.00
Base Cushion Back, Includes All
Modifications & Labour
For Digitizing Or Plastering
SEBWB0015
1
$2,079.00
Precision - Fit Back Cushion Upcharge,
Extra
Wide Or Extra Tall, 20" - 24"
SEBWB0022
1
$240.00
Precision - Fit Back Cushion, Subtle,
Moderate Or Aggresive
Positioning. Includes Hinged Or Fixed
Laterals And Cover.
SEBWB0020
1
$1,078.00
Sizes 20x19 And 22x19
SEBX10050
1
$435.00
Standard, Reclining Or Tilt And
Recline Back Greater Than 20" Wide
SEBX10025
1
$600.00
Synergy Shape 2 Back - Standard
SEBX10035
1
$575.00
Precision
Back Sewn Cover Waterproof Foam,
Rehab
Includes Labour For
Manufacturing Digitizing Or Plastering
Pride Mobility
Products
ADP
Approved
Amt.
Page: 18 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Manufacturer
Pride Mobility
Products
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Synergy Shape 2 Back - Tall
SEBX10040
1
$594.00
Synergy Shape 2 Back Synergy Shape
2 Back - Low
SEBX10030
1
$522.00
Synergy Shape Back Sizes 16x19,
18x19, 20x19
SEBX10010
1
$639.00
Synergy Shape Back Synergy Shape
Back Sizes 14x19 & 22x19
SEBX10005
1
$639.00
Synergy Shape Deep Backs Synergy
Shape Deep Standard Sizes
SEBX10055
1
$660.00
Synergy Shape Deep Tall Sizes
SEBX10060
1
$680.00
Synergy Shape Gp Sizes 14x19 16x19
18x19
SEBX10045
1
$396.00
Synergy Tru Comfort Back Standard,
Reclining Or Tilt And
Recline Back Up To 20" Wide
SEBX10020
1
$556.00
Quickie
Contour Back - Tilt Fx
SEBQU0400
1
$416.00
Ride Designs
Corbac Adjustable Contour Back
Support,
All Sizes
SEBR40005
1
$392.00
Custom Back Support Ride Custom
Back Support
SEBR40010
1
$2,613.00
Jetstream Pro Back System Standard
Back (16" Height) All Standard Sizes
14" - 18"
SEBRO3005
1
$1,495.00
Low Back (10" Height) All Standard
Sizes 14" - 18"
SEBRO3010
1
$1,195.00
Lumbar Support Cushion (Made To
Order)
SEBRO2015
1
$395.00
Recliner Wheelchair Cushion-Custom
(More Than 2 Sections And/Or 2
Halves)
SEBRO2010
1
$1,400.00
Special Application Cushions Recliner
Wheelchair Cushion Made To Order
(One Piece Back & Seat- 2 Sections,2
Valves)
SEBRO2005
1
$1,200.00
Starkey Viennatone
Back Butterfly Back System
SEBV10005
1
$340.00
Supracor
Stimulite Lumbar Support
SEBRR0010
1
$127.00
The Comfort
Company
Acta-Back, All Variations, All Sizes
Roho
SEB7C0010
1
$754.00
Acta-Back, All Variations, Custom Sizes SEB7C0015
1
$1,339.00
Incrediback, Modable, Tall, Deep, TallDeep,
Custom Sizes
SEB7C0025
1
$1,520.00
Incrediback, Moldable, Tall, Deep, TallDeep,
All Sizes
SEB7C0020
1
$747.00
Page: 19 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Back Support
Complete Assembly
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Toronto
Orthopedic
Ltd.
Tops Back Cushion (10" & 12" Width)
SEBTP0005
1
$246.00
Varilite
Medical
Products
E Back - Regular
SEBVP0090
1
$555.00
E Back - Regular Bariatric
SEBVP0092
1
$737.00
E Back - Tall
SEBVP0095
1
$583.00
Evolution Back - Regular
SEBVP0050
1
$781.00
Evolution Back - Regular Bariatric
SEBVP0055
1
$1,092.00
Evolution Back - Tall
SEBVP0060
1
$865.00
Evolution Deep Back - All Sizes
SEBVP0070
1
$1,134.00
Icon Back - Bariatric
SEBVP0120
1
$1,119.00
Icon Back - Deep
SEBVP0115
1
$1,025.00
Icon Back - Low
SEBVP0100
1
$717.00
Icon Back - Tall
SEBVP1110
1
$839.00
Icon Back -Mid
SEBVP0105
1
$746.00
Talon Back - All Sizes
SEBVP0080
1
$555.00
Vicair
Academy Back System
SEBV10010
1
$929.00
Vision
Wheelchair
Seating
Systems Inc.
Virtuoso Contoured Positioning Back
For 16" Or 18" W/C
SEBVC0005
1
$491.00
Virtuoso Contoured Positioning Back,
Custom
SEBVC0010
1
$639.00
Viscount Tall Back Support For 16' Or
18" W/C
SEBVC0030
1
$1,201.00
Viscount Tall Back Support, Custom
Sizes
SEBVC0035
1
$1,517.00
Viva Contoured Postural Back
14"-16" W/C Or 16"-18" W/C
SEBVC0015
1
$229.00
Viva Contoured Postural Back, Custom
SEBVC0020
1
$311.00
Adaptive
Engineering
Lab
Contoured Seat System
(Includes Seat, Back, Support Pads,
Hardware)
SECE10020
1
$1,225.00
Adaptive
Equipment
Systems
(Aes)
Basis Contoured Seat & Back Including
Connecting Hinge
(Select Type). Does Not Include
Mounting Hardware.
SEC2L0010
1
$860.00
Basis Contoured Seat & Back Including SEC2L0020
Connecting Hinge
Package. Li'L Kiddos,14" Wide Or Less.
Does Not Include
Mounting Hardware.
1
$1,040.00
Basis Seat & Back Including
Connecting Hinge (Select Type).
Does Not Include Mounting Hardware.
1
$592.00
SEC2L0005
Page: 20 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Complete Assembly
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Adaptive
Equipment
Systems
(Aes)
Basis Seat & Back Including
Connecting Hinge Package. Li'L
Kiddos,14" Wide Or Less. Does Not
Include Mounting Hardware.
SEC2L0015
1
$690.00
Amysystems
Bariatric Bariatric 45 Cg Power Tilt
SEC4P0060
1
$7,462.00
Cg Power Tilt And Power Recline With
Integrated Shear
Reduction (Isr)
SEC4P0070
1
$12,128.00
Power Recline With Integrated Shear
Reduction (Isr)
SEC4P0065
1
$8,115.00
Broda
Hsp Padding Package
(Includes Short Wing Cover, Extended
Shoulder Bolsters,
Full Extension Foot Pad, F-2 Foot Rest,
Thigh Belt)
SECB-0005
1
$563.00
Convaid
Mountee Seating System
SECCO0020
1
$497.00
Custom
Fabricated
Complete Seating Systems Modify Or
Refurbish Existing Custom Seating
System.
Includes Parts,Hardware,Labour
Changes To Head Rest,Back
Support,Seat, & Footrest Etc.
SEMCF900L
1
$500.00
Invacare
Kinesthetic Seating System Fits 16" To
20" Wide W/C,
(Includes Basic Headrest, Lateral
Supports, Padded Lap Belt,
Ulti-Mate Base & Curved Back)
SECNS0010
1
$1,311.00
Kinesthetic Seating System Kinesthetic
Seating System Fits 10" To 14" Wide
W/C,
(Includes Basic Headrest, Lateral
Supports, Padded Lap Belt,
Ulti-Mate Base, Curved Back & Growth
Bracket)
SECNS0005
1
$1,311.00
Tlc Shell Assembly With Contour
Seating
SECKT2010
1
$1,148.00
Tlc Shell Assembly With Planar Seating
SECKT2005
1
$916.00
Xpress Adjustable Contour Seating
Package
SECKT3005
1
$896.00
Xpress Shell Assembly With Contour
Seating
SECKT3015
1
$896.00
Xpress Shell Assembly With Planar
Seating
SECKT3010
1
$643.00
Bingo Ius Or Xps Seat Frame Size 1
SECK20005
1
$1,568.00
Bingo Ius Or Xps Seat Frame Size 2
SECK20010
1
$1,592.00
Ius Adaptive Seat And Back Cushions
With Airflex
SECK20105
1
$704.00
Ius Adaptive Seat And Back Cushions Breathable
SECK20100
1
$260.00
Kid Kart
Kids Up Inc
Page: 21 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Complete Assembly
Headrest/Neckrest
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Motion
Concepts
Trx Single Pivot Systems, Sp, Super
Low Power Tilt Only For Invacare,
Quantum, And Quickie Bases.
SECZG2005
1
$5,250.00
Otto Bock
Kimba Spring Multifunctional Seating
Unit - Size 1
Includes Elevating Legrests, Flip-Up
Footrest, Laterals,
Adjustable Hip Pads & Padding.
SECOB3005
1
$1,516.00
Kimba Spring Multifunctional Seating
Unit - Size 2
Includes Elevating Legrests, Flip-Up
Footrest, Laterals,
Adjustable Hip Pads & Padding.
SECOB3010
1
$1,596.00
Kimba Spring Plus Adjustable Seating
System - Size 1
Includes Armrests, Elevating Legrests,
Adjustable
Footplates & Recline.
SECOB4005
1
$1,456.00
Kimba Spring Plus Adjustable Seating
System - Size 2
Includes Armrests, Elevating Legrests,
Adjustable
Footplates & Recline.
SECOB4010
1
$1,640.00
Mygo Seat Shell Size 1
Includes Seat Shell And Cushions
SECOB4015
1
$1,808.00
Mygo Seat Shell Size 2
Includes Seat Shell Cushions And
Shoulder Support
SECOB4020
1
$2,079.00
Squiggles Seat Shell
Includes Seat Shell And Cushions
SECOB4025
1
$1,712.00
Spenco
Silicore Chair Seat With Back
SECSO0010
1
$122.00
Toronto
Orthopedic
Ltd.
Tops Seating System
Includes Butterfly Chest Strap,
Combination Head/Neckrest
Tilt Tray, Stroller Interface, Back And
Seat
SECTP0005
1
$1,562.00
Adaptive
Engineering
Lab
Curved Headrest
SEHE10015
1
$102.00
Tri-Pad Headrest
SEHE10005
1
$315.00
Adaptive
Equipment
Systems
(Aes)
Curved Hr Pad Or Contoured Hr Pad Or SEH2L0035
Bell Curved Hr Pad,
Cobra Headrest Bracket, Flip-Down.
1
$527.00
Curved Hr Pad Or Contoured Hr Pad Or SEH2L0030
Bell Curved Hr Pad,
Cobra Headrest Bracket.
1
$442.00
Lateral-Posterior Head Support,
Adjustable Depth Bracket,
6-1/2"W X 7"H.
SEH2L0015
1
$412.00
Lateral-Posterior Head Support,
Adjustable Depth Bracket,
Hinged.
SEH2L0005
1
$450.00
Page: 22 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Headrest/Neckrest
Manufacturer
Adaptive
Equipment
Systems
(Aes)
Advanced
Mobility
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Lateral-Posterior Head Support,
Adjustable Depth Bracket,
Paediatric 4" X 4" Or 5"X 5" Or 6"X 6".
SEH2L0010
1
$391.00
Lateral-Posterior Head Support, Cobra
Headrest Bracket,
5" X 5"Or 6" X 6" Or 7" X 7"Or 8" X 8".
SEH2L0020
1
$538.00
Lateral-Posterior Head Support, Cobra
Style Headrest
Bracket, Flip-Down 5" X 5"Or 6"X6" Or
7"X7" Or 8" X8".
SEH2L0025
1
$622.00
Custom Headrest
SEHAO0015
1
$200.00
Deep "U" Headrest
SEHAO0020
1
$156.00
Large Padded Headrest
SEHAO0025
1
$116.00
Macintosh Oxbow Headrest
SEHAO0010
1
$200.00
So Soft Oval Headrest
SEHAO0030
1
$156.00
Standard Curved Padded Headrest
SEHAO0005
1
$116.00
Amysystems
Curved Headrest, All Sizes
SEH4P0010
1
$187.00
Broda
Neckrest Cushion
SEHB-0010
1
$47.00
Convaid
Mountee Cushioned Headrest Support
SEHCO0020
1
$633.00
Custom
Fabricated
Adjustable Headrest With Neckrest,
Vinyl Cover,
Without Hardware
SEHCF080L
1
$420.00
Complex Headrest/Contoured Or
Molded, Vinyl Cover,
Without Hardware
SEHCF060L
1
$310.00
Contoured Headrest/Curved Surface,
Vinyl Cover,
Without Hardware
SEHCF050L
1
$200.00
Flat Headrest/Planar Head Support,
Vinyl Cover,
Without Hardware
SEHCF040L
1
$125.00
Head Or Neckrest Incorporated With
Mobility Switches,
Vinyl Cover, Without Hardware
SEHCF090L
1
$310.00
Neckrest With Vinyl Cover, Without
Hardware
SEHCF070L
1
$190.00
Daher
Specialty
Foam
Products
Combination Headrest
SEHDH0010
1
$58.00
Full Support Headrest
SEHDH0015
1
$77.00
Large Headrest
SEHDH0005
1
$58.00
Danmar
Products Inc.
Large Mounted Hensinger
SEHDM0300
1
$225.00
Medium Hensinger With High Back
SEHDM1550
1
$203.00
Medium Mounted Hensinger
SEHDM0250
1
$212.00
Medium Unmounted Hensinger
SEHDM0050
1
$173.00
Small Unmounted Hensinger
SEHDM0010
1
$160.00
Page: 23 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Headrest/Neckrest
Manufacturer
Future
Mobility
Handicare
Invacare
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Large Headrest With Multi-Axial
Hardware
SEHFM0015
1
$284.00
Large Padded Headrest
SEHFM0005
1
$220.00
Small Headrest With Multi-Axial
Hardware
SEHFM0020
1
$280.00
Small Padded Headrest
SEHFM0010
1
$216.00
Emineo Advanced Headrest
SEHM90105
1
$360.00
Emineo Manual Wheelchair Emineo
Basic Headrest
SEHM90100
1
$236.00
Ibis Manual Wheelchair Small Headrest
Assesmbly
SEHM90005
1
$132.00
Large Headrest
SEHM90015
1
$148.00
Lateral Support Headrest
SEHM90010
1
$140.00
Offset Headrest Large
SEHM90030
1
$212.00
Offset Headrest Lateral
SEHM90025
1
$204.00
Offset Headrest Small
SEHM90020
1
$196.00
Basic Headrest - Adult
SEHNS1010
1
$221.00
Comfort Plus Headrest Systems
Comfort Plus, Large 14" Pad/Standard
Hardware
SEHNS3005
1
$280.00
Comfort Plus, Large 14" Pad /Multi Axis
Hardware
SEHNS3020
1
$338.00
Comfort Plus, Medium 10" Pad/Multi
Axis Hardware
SEHNS3030
1
$338.00
Comfort Plus, Medium 10"
Pad/Standard Hardware
SEHNS3010
1
$280.00
Comfort Plus, Swingaway Both Sides,
Standard
Lateral Pad/Spot Pad/Long Lateral Pad
SEHNS3060
1
$494.00
Comfort Plus, Swingaway Left Side,
Standard
Lateral Pad/Spot Pad/Long Lateral Pad
SEHNS3070
1
$375.00
Comfort Plus, Swingaway R1ght Side,
Standard
Lateral Pad/Spot Pad/Long Lateral Pad
SEHNS3065
1
$375.00
Curved Adjustable Headrest System
SEHNS1030
1
$329.00
Large 14" Comfort Pad Only (With
Ring)
SEHNS3015
1
$165.00
Large Adjustable Headrest System
SEHNS1020
1
$354.00
Large Combo With Large Sub Occipital
SEHNS2007
1
$1,026.00
Medium 10" Comfort Pad Only (With
Ring)
SEHNS3025
1
$165.00
Otto Bock Style, Swing Away Both
Sides, Standard
Lateral Pad/Spot Pad/Long Lateral Pad
SEHNS3075
1
$557.00
Page: 24 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Headrest/Neckrest
Manufacturer
Invacare
Jay Medical
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Otto Bock Style, Swingaway Left Side,
Standard
Lateral Pad/Spot Pad/Long Lateral Pad
SEHNS3085
1
$426.00
Otto Bock Style, Swingaway Right Side, SEHNS3080
Standard
Lateral Pad/Spot Pad/Long Lateral Pad
1
$426.00
Pindot Headrests Basic Headrest Child
SEHNS1005
1
$221.00
Small Adjustable Headrest System
SEHNS1015
1
$354.00
Small Combo With Large Sub Occipital
SEHNS2009
1
$1,026.00
Stealth Combo Headrest With Multi
Axis Hardware,
Large & Small Sizes
SEHNS2050
1
$536.00
Stealth I2i Headrest System - All Sizes
SEHNS2060
1
$822.00
Stealth Ultra Channel With Ring, Large
& Small Sizes
SEHNS2020
1
$647.00
Stealth Ultra Headrest Systems Stealth
Occipital/Sub Occipital & Laterals,
Adult & Paediatric Sizes (Specify
Swingaway)
SEHNS2005
1
$1,133.00
Stealth Ultra Occipital & Laterals,
Small & Large Sizes (Specify
Swingaway)
SEHNS2015
1
$803.00
Stealth Ultra Occipital Large/Small
SEHNS2030
1
$330.00
Stealth Ultra Small & Occipital/Sub
Occipital
SEHNS2010
1
$659.00
Stealth Ultra Sub Occipital Large/Small
SEHNS2025
1
$330.00
Stealth Ultra Swing Both Sides,
Standard Lateral
Pad/Spot Pad/Long Lateral Pad
SEHNS2035
1
$474.00
Stealth Ultra Swingaway
Standard & Long Lateral Pad, Or Spot
Pad
SEHNS2045
2
$375.00
Stealth Ultra-Ac Adjustable Channel
SEHNS2040
1
$313.00
Two Step Adjustable Headrest System
SEHNS1025
1
$329.00
Four Pad Headrest - Junior
SEHJA0016
1
$294.00
Four Pad Rotational Headrest - Junior
SEHJA0018
1
$440.00
Four Pad Rotational Headrest Standard
SEHJA0017
1
$440.00
Full Width Headrest
SEHJA0020
1
$147.00
Jay Fit Single Pad Headrest - Small
SEHJA0005
1
$84.00
Single Pad Headrest - Large
SEHJA0006
1
$84.00
Three Pad Headrest - Large
SEHJA0011
1
$210.00
Three Pad Headrest - Large Junior
SEHJA0013
1
$210.00
Three Pad Headrest - Small
SEHJA0010
1
$210.00
Page: 25 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Headrest/Neckrest
Manufacturer
Jay Medical
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Three Pad Headrest - Small Junior
SEHJA0012
1
$210.00
Three Pad Rotational Headrest - Large
SEHJA0027
1
$352.00
Three Pad Rotational Headrest - Large
Junior
SEHJA0029
1
$352.00
Three Pad Rotational Headrest - Small
SEHJA0026
1
$352.00
Three Pad Rotational Headrest - Small
Junior
SEHJA0028
1
$352.00
Xpress Micro Adjustable Head Support
SEHKT3010
1
$245.00
Xpress Planar Head Support
SEHKT3015
1
$160.00
Xpress Tri-Wing Adjustable Head
Support
SEHKT3005
1
$124.00
Kids Up Inc
Ius Headrest
SEHK20005
1
$288.00
Lpa Medical
Inc.
Cervical Support
SEHO12005
1
$42.00
Contour Headrest
SEHO12010
1
$100.00
Maple Leaf
Power Plus
Contour Headrest Including Brackets
SEHWM0005
1
$256.00
Metalcraft
Industries
Contoured Headrest With Mounting
Hardware
Small, Large, Xlarge
SEHNG0005
1
$301.00
Occipital Ring With Mounting Hardware
Small & Large Child Or Adult
SEHNG0015
1
$345.00
Occipital Ring, Add-On, With Mounting
Hardware
Small & Large Child Or Adult
SEHNG0020
1
$301.00
Motion
Concepts
Onyx Auto Style Headrest
SEHZG0005
1
$187.00
Orthofab
Padded Contour Support Without
Mounting Hardware,
Small, Medium, Or Large
SEHOF1005
1
$106.00
Otto Bock
Adjustable Wing Headrest (Size 1 & 2)
SEHOB6020
1
$562.00
Fixed Wing Headrest (Size 1 & 2)
SEHOB6015
1
$396.00
Headrest - Large/Small
SEHOB0100
1
$84.00
Headrest - Lateral Control
SEHOB0050
1
$136.00
Headrest Headrest - Combination
SEHOB0010
1
$83.00
Kimba Spring Headrests Headrest
Support (Size 1 & 2)
SEHOB6005
1
$286.00
Kimba Spring Plus Headrests
Contoured Headrest (Size 1 & 2)
SEHOB6010
1
$160.00
Neckrest - All Sizes
SEHOB0250
1
$95.00
Soft Headrest - Large/Small
SEHOB0110
1
$120.00
X-Style Headrest/Neckrest
Combination, Adult &
Paediatric Sizes.
SEHOB0015
1
$125.00
Kid Kart
Page: 26 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Headrest/Neckrest
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Performance
Health
Products
V-Trak Headrest, All Sizes, All
Configurations
SEHP00005
1
$360.00
Permobil
Headrest - For Ergo Back
SEH1P0005
1
$470.00
Precision
Headreast - Large (14") Or Small (10")
Rehab
Pad
Manufacturing
SEHWB0010
1
$120.00
The Comfort
Company
Headrest - Moldable, Includes Cover
SEH7C0015
1
$218.00
Vision
Wheelchair
Seating
Systems Inc.
Vector Head N Neck Support, 11"W X
8"D Pad
SEHVC0005
1
$232.00
Vector Head N Neck Support, Custom
Pad
SEHVC0010
1
$328.00
Whitmyer
Biomechanix
10" Plush Occipital Pad & Single SubOccipital Pad
With Onyx Vertical/Horizontal Mount
SEHWH7020
1
$393.00
10" Plush Occipital Pad & Single SubOccipital Pad
With Pro Verticial/Horizontal Mount
SEHWH7035
1
$430.00
14" Plush Pad With Linx
Vertical/Horizontal Mount
SEHWH5010
1
$228.00
14" Plush Pad With Onyx
Vertical/Horizontal Mount
SEHWH5030
1
$228.00
14" Plush Pad With Pro
Vertical/Horizontal Mount
SEHWH5040
1
$244.00
19" Plush Pad With Link
Vertical/Horizontal Mount
SEHWH5015
1
$334.00
19" Plush Pad With Onyx
Vertical/Horizontal Mount
SEHWH5032
1
$302.00
19" Plush Pad With Pro
Vertical/Horizontal Mount
SEHWH5045
1
$339.00
4"X6" Occipital Pad & Single SubOccipital Pad
With Onyx Vertical/Horizontal Mount
SEHWH7025
1
$334.00
4"X6" Occipital Pad & Single SubOccipital Pad
With Pro Vertical/Horizontal Mount
SEHWH7040
1
$371.00
4"X6"Occipital Pad & Single SubOccipital Pad
With Lynx Vertical/Horizontal Mount
SEHWH7010
1
$366.00
4"X6"Occipital Pad With Size 1/2 SubOccipital Pads
With Onyx Vertical/Horizontal Mount
SEHWH7065
1
$344.00
4"X6"Occipital Pad With Size 1/2 SubOccipital Pads
With Pro Vertical/Horizontal Mount
SEHWH7080
1
$482.00
8" Or 10" Plush Pad With Lightweight
Vertical/Horizontal Mount
SEHWH5020
1
$218.00
Page: 27 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Headrest/Neckrest
Manufacturer
Whitmyer
Biomechanix
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
8" Or 10" Plush Pad With Onyx
Vertical/Horizontal Mount
SEHWH5025
1
$218.00
8" Or 10" Plush Pad With Pro
Vertical/Horizontal Mount
SEHWH5035
1
$234.00
8"/10" Plush Occipital Pad With Size 1
Sub-Occipital Pads
With Pro Vertical/Horizontal Mount
SEHWH7085
1
$541.00
8"/10" Plush Occipital Pad With Size
1sub-Occipital Pads
With Lynx Vertical/Horizontal Mount
SEHWH7055
1
$498.00
8"/10" Plush Occipital Pad With Size
1sub-Occipital Pads
With Onyx Vertical/Horizontal Mount
SEHWH7070
1
$525.00
Adjust-A-Plush Headrest System
SEHWH7260
1
$272.00
Bilateral Lfc With Pads And Interface
Plate
For Plush & Contoured Cradle Systems
SEHWH7235
1
$461.00
Contoured Cradle Single Pad Headrest
Systems Small Pad With Linx
Vertical/Horizontal Mount
SEHWH5050
1
$143.00
Large Pad With Lightweight
Vertical/Horizontal Mount
SEHWH5075
1
$165.00
Large Pad With Linx Vertical/Horizontal
Mount
SEHWH5060
1
$165.00
Large Pad With Onyx
Vertical/Horizontal Mount
SEHWH5090
1
$212.00
Large Pad With Pro Vertical/Horizontal
Mount
SEHWH5110
1
$228.00
Medium Pad With Lightweight
Vertical/Horizontal Mount
SEHWH5070
1
$154.00
Medium Pad With Lightweight
Vertical/Horizontal Mount
SEHWH5085
1
$202.00
Medium Pad With Linx
Vertical/Horizontal Mount
SEHWH5055
1
$154.00
Medium Pad With Pro
Vertical/Horizontal Mount
SEHWH5105
1
$175.00
Occipital Pad With Size 3/4 SubOccipital Pads
1"X4",4"X6",1"X4" With Onyx
Vertical/Horizontal Mount
SEHWH7115
1
$456.00
Occipital Pad With Size 3/4 SubOccipital Pads
1"X4",4"X6",1"X4" With Pro
Vertical/Horizontal Mount
SEHWH7125
1
$482.00
Plush Headrest Systems 8" Or 10"
Plush Pad With Linx Vertical/Horizontal
Mount
SEHWH5005
1
$218.00
Page: 28 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Headrest/Neckrest
Manufacturer
Whitmyer
Biomechanix
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Plush Lateral Facial Support Options
Unilateral Lfc With Pads And Interface
Plate
For Plush & Contoured Cradle Systems
SEHWH7230
1
$250.00
S.O.F.T. Adult Head Support Sysytems
4"X6"Occipital Pad With Size 1/2 SubOccipital Pads
With Lynx Vertical/Horizontal Mount
SEHWH7050
1
$440.00
S.O.F.T. Head Support Systems 10"
Plush Occipital Pad & Single SubOccipital Pad
With Linx Vertical/Horizontal Mount
SEHWH7005
1
$419.00
S.O.F.T. Lateral Facial Support Options
Lateral Facial Component With Pad
SEHWH7250
2
$212.00
S.O.F.T. Paediatric Head Support
Systems Occipital Pad With Size 3/4
Sub-Occipital Pads
1"X4",4"X6",1"X4" With Lynx
Vertical/Horizontal Mount
SEHWH7105
1
$440.00
Single Pad Anterior Support Options
Single Pad Dynamic Forehead Strap
System All Sizes
SEHWH7200
1
$292.00
Single Pad Static Forehead Strap
System All Sizes
SEHWH7205
1
$308.00
Small Pad With Lightweight
Vertical/Horizontal Mount
SEHWH5065
1
$143.00
Small Pad With Onyx
Vertical/Horizontal Mount
SEHWH5080
1
$191.00
Small Pad With Pro Vertical/Horizontal
Mount
SEHWH5095
1
$165.00
T-Bar Occipital Pads & Single SubOccipital Pad
2.25"X7" & 2.25"X5" With Linx
Vertical/Horizontal Mount
SEHWH7015
1
$652.00
T-Bar Occipital Pads & Single SubOccipital Pad
2.25"X7" & 2.25"X5" With Onyx
Vertical/Horizontal Mount
SEHWH7030
1
$620.00
T-Bar Occipital Pads & Single SubOccipital Pad
2.25"X7" & 2.25"X5" With Pro
Vertical/Horizontal Mount
SEHWH7045
1
$663.00
T-Bar Occipital Pads With Size 1 SubOccipital Pads
2.25"X7" With Pro Vertical/Horizontal
Mount
SEHWH7090
1
$737.00
T-Bar Occipital Pads With Size 1subOccipital Pads
2.25"X7" With Linx Vertical/Horizontal
Mount
SEHWH7060
1
$694.00
Page: 29 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Headrest/Neckrest
Seat Cushion
Manufacturer
Whitmyer
Biomechanix
Action
Products
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
T-Bar Occipital Pads With Size 1subOccipital Pads
2.25"X7" With Onyx Vertical/Horizontal
Mount
SEHWH7075
1
$710.00
T-Bar Occipital Pads With Size 3 Single
Sub-Occipital Pads
2.25"X5" With Linx Vertical/Horizontal
Mount
SEHWH7110
1
$694.00
T-Bar Occipital Pads With Size 3 Single
Sub-Occipital Pads
2.25"X5" With Onyx Vertical/Horizontal
Mount
SEHWH7120
1
$710.00
T-Bar Occipital Pads With Size 3 Single
Sub-Occipital Pads
2.25"X5" With Pro Vertical/Horizontal
Mount
SEHWH7130
1
$737.00
Centurian Cushion
16x16,16x81,18x16,18x18
SESAN2205
1
$265.00
Centurian Cushion 18x20,20x18,20x20
SESAN2210
1
$468.00
Centurian Cushion Large Custom Sizes
SESAN2225
1
$491.00
Centurian Cushion Small Custom Sizes
SESAN2215
1
$402.00
Centurian Cushion Xlarge Custom
Sizes
SESAN2230
1
$612.00
Commuter Cushion
16x16,16x18,18x16,18x18
SESAN4405
1
$240.00
Commuter Cushion 18x20,20x18,20x20
SESAN4410
1
$468.00
Commuter Cushion Large Custom
Sizes
SESAN4425
1
$459.00
Commuter Cushion Medium Custom
Sizes
SESAN4420
1
$407.00
Commuter Cushion Small Sizes
SESAN4415
1
$370.00
Pilot Cushion
16x16,16x18,18x16,18x18
SESAN3305
1
$310.00
Pilot Cushion 18x20,20x18,20x20
SESAN3310
1
$431.00
Pilot Cushion Large Custom Sizes
SESAN3325
1
$558.00
Pilot Cushion Medium Custom Sizes
SESAN3320
1
$482.00
Pilot Cushion Small Custom Sizes
SESAN3315
1
$418.00
Pilot Cushion Xlarge Sizes
SESAN3330
1
$647.00
Pilot Cushion Xxxlarge Custom Sizes
SESAN3340
1
$916.00
Professional Cushion
16x16,16x18,18x16,18x18
SESAN1105
1
$310.00
Professional Cushion
18x20,20x18,20x20
SESAN1115
1
$665.00
Professional Cushion Large Custom
Sizes
SESAN1130
1
$698.00
Page: 30 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Action
Products
Adaptive
Engineering
Lab
Adaptive
Equipment
Systems
(Aes)
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Professional Cushion Medium Custom
Sizes
SESAN1125
1
$597.00
Shear Smart Pad
16x16,16x18,18x16,18x18
SESAN5505
1
$210.00
Shear Smart Pad 18x20, 20x18, 20x20
SESAN5510
1
$250.00
Xact Classic Cushion
SESAN9905
10x10,16x14,17x17,16x20,18x20,20x20
1
$695.00
Xact Classic Cushion
16x16,16x18,18x16,18x18
SESAN9910
1
$595.00
Xact Individual Cushion All Custom
Sizes
SESAN9915
1
$1,195.00
Xact Individual Cushion Custom Sizes
SESAN9920
1
$1,195.00
Xact Integrated Cushion With Drop
Seat 16x20,18x20, 20x20
SESAN9010
1
$750.00
Xact Integrated Drop Base Sizes 10x10
To 18x18
SESAN9005
1
$695.00
Xact Lite Cushion 16x16 - 18x18
SESAN9015
1
$425.00
Xact Lite Cushion 18x20 - 20x20
SESAN9020
1
$450.00
Xact Soft Foam Cushion 16x16, 16x18,
18x16, 18x18
SESAN9980
1
$595.00
Xact Soft Foam Cushion 16x20,18x20,
20x16, 20x18, 20x20
SESAN9985
1
$750.00
Xact Soft Foam Cushion With
Integrated Drop Seat, All Sizes
SESAN9990
1
$750.00
Drop-In Seat With 1.5" Sun-Mate Or
Pudgee Foam
SESE10030
1
$213.00
Drop-In Seat With Contour One Foam
SESE10035
1
$303.00
Drop-In Seat With Poly Foam
SESE10020
1
$194.00
Full-Width Seat With 1.5" Sun-Mate Or
Pudgee Foam
SESE10065
1
$376.00
Full-Width Seat With 1.5" Un-Mate Or
T-Foam
SESE10055
1
$213.00
Full-Width Seat With Contour-One
Foam
SESE10070
1
$303.00
Full Width Solid Seat Package With J
Or Flush Or Drop Hooks
& Hold Downs.
SES2L0010
1
$648.00
Offset, T Style, I Style, Anti-Thrust Or
Medial Thigh
Support Solid Seat Insert, Includes TNuts.
SES2L1015
1
$269.00
Oversize Upcharge For Seats Over 2o"
But Less Than 28".
SES2L1035
1
$80.00
Quick Fit Anti-Thrust Or Contour Solid
Seat Insert, Includes
T-Nuts.
SES2L1020
1
$491.00
Page: 31 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Adaptive
Equipment
Systems
(Aes)
Advanced
Mobility
Airerx
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Quick-Fit Contoured, Adjustable Split,
Or Foam Form Solid
Seat Insert, Incudes T-Nuts.
SES2L1030
1
$569.00
Sculptured Solid Set Insert, Includes TNuts, Custom.
SES2L1025
1
$999.00
Sculpturefit Seat Package 2/Attaching
Hardware, Custom.
SES2L0015
1
$1,236.00
Seats Hardware Not Included Solid
Seat Insert, Includes T-Nuts.
SES2L1005
1
$183.00
Seats Including Front & Rear Mounting
Hardware Solid Seat Package
W/Universal Or E-Z Mount Hardware.
SES2L0005
1
$542.00
Solid Seat Insert Package, Li'L Kiddos,
14" Wide Or Less.
SES2L0020
1
$635.00
Solid Seat Insert Package, Li'L Kiddos,
Contoured, 14" Wide
Or Less.
SES2L0025
1
$821.00
Solid Seat Insert, Includes T-Nuts, Li'L
Kiddos,
14" Wide Or Less.
SES2L1010
1
$247.00
All Star Cushion Custom Sizes Includes
Cover
SESAO0080
1
$583.00
All Star Cushion Includes
Cover And Sizes 16x16 16x18 16x18
17x17 18x16 18x18
SESAO0085
1
$516.00
All Star Drop Base, Custom Sizes
Includes
Cover, Base, 4 Drop Hooks
SESAO0095
1
$661.00
All Star Drop Base, Includes
Cover, Base, 4 Drop Hooks
SESAO0090
1
$575.00
Comfort Contoured Cushion
SESAO0030
1
$140.00
Darlexx Covered Cushion
SESAO0010
1
$116.00
Gel Flotation Pad
SESAO0110
1
$324.00
Multi Density Seat Cushion
SESAO0020
1
$140.00
Pro Custom Cushion With Built In Drop
Base
SESAO0070
1
$615.00
Pro-Custom Cushion With Covers
SESAO0075
1
$564.00
Sunmate Cushion
SESAO0005
1
$156.00
Superstar Cushion Includes
Cover 16x16, 16x18, 18x16, 18x18
SESAO0100
1
$600.00
Superstar Drop Base, Size 17x17,
Includes
Cover, Base, 4 Drop Hooks
SESAO0105
1
$700.00
Upcharge For Custom Sizes Other
Than 17x17
SESAO0115
1
$79.00
Gu - All Sizes
SESUA0005
1
$350.00
Page: 32 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
ADP Code
Max
Allowed
Qty.
Sp - All Sizes
SESUA0010
1
$595.00
Spp - All Sizes
SESUA0015
1
$775.00
Contour Seat Cushion, Non-Standard
Sizes
SES4P0015
1
$607.00
Contour Seat Cushion, Standard Sizes
SES4P0010
1
$513.00
Contour Seat For Heavy Duty
SES4P0020
1
$716.00
Bioform Reha
Foundation Cushion - All Sizes
SESZB0005
1
$484.00
Blake Medical
Geomatrix Geomatrix Bronze
SESG00005
1
$427.00
Geomatrix Gold, Gold+
SESG00015
1
$613.00
Geomatrix Gold, Gold+ Custom Sizes
SESG00020
1
$720.00
Geomatrix Hybrid Or Hybrid Deep
SESG00030
1
$652.00
Geomatrix Platinum
SESG00025
1
$872.00
Geomatrix Silver
SESG00010
1
$560.00
Broda
Seat Pad
SESB-0010
1
$61.00
Calko Rehab
Canada
Standard Sizes 12x12 To 20x20
SESK90005
1
$767.00
Standard Sizes 12x12 To 20x20
SESK90010
1
$913.00
Standard Sizes 12x12 To 20x20
SESK90015
1
$1,000.00
Debbonair Dynamics/Cushionair
Cushion
- Greater Than 20" Width Or Depth
SESGC0015
1
$676.00
Debbonair Dynamics/Cushionair
Cushion
- Up To 20" Width Or Depth
SESGC0010
1
$583.00
Debbonair Dynamics/Cushionair
Cushion Debbonair
Dynamics/Cushionair Cushion
- Standard Sizes
SESGC0005
1
$546.00
Complex Indirect Molded Seat, Without
Cover
& Mounting Hardware
SESCF105L
1
$1,460.00
Contoured Seat, Includes Cover,
Without Hardware
SESCF103L
1
$600.00
Flat Seat/Rigid Base, Includes Cover,
Without Hardware
SESCF101L
1
$300.00
Sculptured Seat, Includes Cover,
Without Hardware
SESCF104L
1
$720.00
Wedged Seat (Thigh Bar), Includes
Cover, Without Hardware
SESCF102L
1
$450.00
Prism Elite Cushion 16x16-20x20
SESFM0060
1
$300.00
Prism Elite Cushion Custom Sizes
SESFM0065
1
$340.00
Prism Ideal Cushion All Sizes
SESFM0050
1
$184.00
Prism Supreme Air Cushion 18x18
Through 20x20
SESFM0030
1
$580.00
Airerx
Amysystems
Clearview
Healthcare
Products
Custom
Fabricated
Future
Mobility
Device
ADP
Approved
Amt.
Page: 33 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Future
Mobility
Handicare
Invacare
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Prism Supreme Air Cushion 18x19
Through 20x19
SESFM0035
1
$600.00
Prism Supreme Air Cushion Custom
Sizes
SESFM0040
1
$628.00
Prism Supreme Cushion 14x14
Through 18x20
SESFM0015
1
$460.00
Prism Supreme Cushion 15x16
Through 20x20
SESFM0020
1
$480.00
Prism Supreme Cushion Custom Sizes
SESFM0025
1
$548.00
Prism Supreme Gel Cushion 14x14
Through 18x20
SESFM0110
1
$540.00
Prism Supreme Gel Cushion 15x16
Through 20x20
SESFM0115
1
$560.00
Prism Supreme Gel Cushion Custom
Sizes
SESFM0120
1
$620.00
Prism Supreme Heavy Duty Cushion
SESFM0125
1
$640.00
Prism Supreme Ii Plus Cushion 14x14
Through 18x20
SESFM0070
1
$460.00
Prism Supreme Ii Plus Cushion 15x16
Through 20x20
SESFM0075
1
$480.00
Prism Supreme Ii Plus Cushion Custom
Sizes
SESFM0080
1
$548.00
Super Cushion For Kids 10x10 Through
16x16
SESFM0090
1
$460.00
Super Cushion For Kids 10x12 Through
16x12
SESFM0095
1
$480.00
Super Cushion For Kids Custom Sizes
SESFM0100
1
$548.00
Emineo Manual Wheelchair Smartsit
Basic Cushion - All Sizes
SESM90100
1
$260.00
Ibis Manual Wheelchair Seat Cushion Sellaskin 16x16,16x18,18x16,18x18
SESM90005
1
$156.00
Smartsit Comfort Cushion - All Sizes
SESM90105
1
$436.00
Support Seat Cushion
SESM90020
1
$300.00
Contour U Seats Includes All
Modifications & Vacuum/Vinyl
Upholstery
SESNS0075
1
$1,340.00
Custom Sizes
SESNS2015
1
$647.00
Essential Cushions Fits 16" To 20"
Wide W/C
SESNS0005
1
$86.00
Extra - Fits 14" To 22" Wide W/C
SESNS0037
1
$166.00
Extra - Special Size Modifications
SESNS0039
1
$166.00
Fits 10" To 14" Wide W/C
SESNS0050
1
$350.00
Fits 10" To 14" Wide W/C
SESNS1040
1
$482.00
Fits 20" To 22" Wide W/C
SESNS2010
1
$574.00
Page: 34 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Invacare
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Gentle Contour (Gc) With Flo Gel,
20"W X 16"D To 22"W X 20"D
SESNS0150
1
$505.00
Gentle Contour (Gc) With Flo Gel,
Builder Size (Custom)
SESNS0155
1
$552.00
Gentle Contour (Gc) With Flo Gel,
14"W X 16"D
To 18"W X 20"D
SESNS0145
1
$505.00
Gentle Contour (Gc) With Visco Foam,
14"W X 16"D To 18"W X20"D
SESNS0130
1
$505.00
Gentle Contour (Gc) With Visco Foam,
20"W X 16"D To 22"W X 20"D
SESNS0135
1
$505.00
Gentle Contour (Gc) With Visco Foam,
Builder Size (Custom)
SESNS0140
1
$552.00
Infinity Airflo Fits 14 To 18" Wide W/C
SESNS2005
1
$567.00
Infinity Cushions Lo Contour (Lc) With
Visco Foam, 14"W X 16"D
To 18"W X 20"D
SESNS0100
1
$505.00
Intouch Stabilite, All Sizes, Includes
Cover
SESNS1085
1
$289.00
Lo Contour (Lc) With Flo Gel,
14"W X 16"D To 18"W X 20"D
SESNS0115
1
$505.00
Lo Contour (Lc) With Flo Gel,
20"W X 16"D To 22"W X 20"D
SESNS0120
1
$505.00
Lo Contour (Lc) With Flo Gel,
Builder Size (Custom)
SESNS0125
1
$552.00
Lo Contour (Lc) With Visco Foam,
Builder Size (Custom)
SESNS0110
1
$552.00
Lo Contour (Lc) With Visco Foam,
20"W X 16"D To 22"W X 20"D
SESNS0105
1
$505.00
Max Contour (Mc) With Flo Gel,
14"W X 16"D To 18"W X 20"D
SESNS0175
1
$528.00
Max Contour (Mc) With Flo Gel,
20"W X 16"D To 22"W X 20"D
SESNS0180
1
$528.00
Max Contour (Mc) With Flo Gel,
Builder Size (Custom)
SESNS0185
1
$575.00
Max Contour (Mc) With Visco Foam,
14"W X 16"D To 18"W X 20"D
SESNS0160
1
$528.00
Max Contour (Mc) With Visco Foam,
20"W X 16"D To 22"W X 20"D
SESNS0165
1
$528.00
Max Contour (Mc) With Visco Foam,
Builder Size (Custom)
SESNS0170
1
$575.00
Naked Contour U Seat, Includes All
Modifications
& Vacuum/Moisture Proof
Coating/Removable Cover
& Cover Pattern.
SESNS0080
1
$1,594.00
Page: 35 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Invacare
Jay Medical
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Silouette Cushions Silhouette Seat
Cushion
SESNS0070
1
$632.00
Single Density Cushions Non Standard
Size
SESNS0015
1
$105.00
Special Adult Size & Modifications
SESNS0045
1
$531.00
Special Adult Size & Modifications
SESNS1035
1
$670.00
Special Junior Size & Modifications
SESNS0055
1
$449.00
Special Junior Size & Modifications
SESNS1045
1
$670.00
Ulti-Mate Bases Fits 16" To 20" Wide
W/C
SESNS1030
1
$529.00
Ulti-Mate Cushions Fits 16" To 20"
Wide W/C
SESNS0040
1
$433.00
14x14/12x12 With Back Support
SESJA3200
1
$225.00
14x16 With Standard Cover
SESJA0425
1
$546.00
15.5x 16, 15.5 X 18 With Standard
Cover
SESJA0420
1
$546.00
16x16, 16x18, 18x16,18x18,20x18 With
Solid Drop Base
SESJA9120
1
$347.00
16x20, 18x20 With 2 Covers
SESJA9040
1
$424.00
17x16, 17x18 Includes Solid Seat, 2
Covers & Hardware
SESJA8017
1
$410.00
17x17
SESJA0485
1
$546.00
17x17 With Incontinent Cover
SESJA0462
1
$550.00
17x17 With Air Exchange Cover
SESJA0442
1
$558.00
18/15.5x20 With Incontinent Cover
SESJA1375
1
$704.00
18x16 To 10x10 With Incontinent Cover
SESJA1350
1
$640.00
18x18, 15.5x18,
SESJA0100
1
$612.00
18x18, 16x18,
SESJA2100
1
$606.00
18x20, 15.5x20
SESJA0250
1
$678.00
18x20, 15.5x20
SESJA1100
1
$718.00
18x20, 15.5x20 With Air Exchange
Cover
SESJA0450
1
$640.00
18x20, 15.5x20 With Incontinent Cover
SESJA0470
1
$630.00
18x20, 15.5x20 With Standard Cover
SESJA0410
1
$630.00
20x16
SESJA0480
1
$630.00
20x16 Includes Solid Seat, 2 Covers &
Hardware
SESJA8015
1
$464.00
20x16, 20x18 With Air Exchange Cover
SESJA0441
1
$640.00
20x16, 20x18 With Incontinent Cover
SESJA0461
1
$630.00
20x16, 20x18, 16x20, 18x20
SESJA0505
1
$620.00
20x16, 20x18, 16x20, 18x20, Solid
Drop Seat Attached
SESJA0605
1
$666.00
Page: 36 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Jay Medical
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
20x18
SESJA0490
1
$618.00
20x18
SESJA9106
1
$347.00
20x18 With Back Support
SESJA3100
1
$212.00
20x18 With Solid Drop Seat
SESJA9125
1
$453.00
20x18, 18x20, 16x20, With Adductor
Wedges
SESJA2200
1
$666.00
20x20
SESJA9505
1
$794.00
20x20 With 2 Covers
SESJA9030
1
$653.00
20x20 With Air Exchange Cover
SESJA0445
1
$737.00
20x20 With Incontinent Cover
SESJA0465
1
$728.00
20x20 With Incontinent Cover
SESJA1400
1
$800.00
20x20 With Standard Cover
SESJA0405
1
$716.00
20x20, 22x16, 22x18
SESJA0507
1
$718.00
20x20, 22x16, 22x18, Solid Drop Seat
Attached
SESJA0610
1
$729.00
20x20, 24x20
SESJA0200
1
$816.00
20x20,24x20 With Quadrant Pads
SESJA1200
1
$855.00
24x18
SESJA0510
1
$758.00
24x20
SESJA9515
1
$841.00
24x20 With Air Exchange Cover
SESJA0455
1
$789.00
24x20 With Incontinent Cover
SESJA0475
1
$784.00
24x20 With Incontinent Cover
SESJA1425
1
$838.00
24x20 With Standard Cover
SESJA0415
1
$794.00
Adjustable Contour Seat For 14" Or 16"
Frame Width,
Various Seat Depths
SESJA9705
1
$398.00
Adjustable Contour Seat For 18" Frame
Width,
Various Seat Depths
SESJA9710
1
$442.00
Bases Jay Foam Base 20" Deep
SESJA6050
1
$235.00
Combi Base 18x16 To 15.5x20
SESJA6400
1
$43.00
Combi Base 20x18
SESJA6500
1
$82.00
Cushion With Flat Or Curved Bottom
Sizes 18x20 Through 20x20
SESJA9810
1
$470.00
Dual Valve - W X D .gt.21 Inches Jay 3
Air Cushion- Dual Valve -Width X
Depth .gt.21 Inches
SESJA9920
1
$884.00
Dual Valve Jay 3 Air Cushion - Dual
Valve
SESJA9910
1
$716.00
Foam Base With Flat Or Curved Bottom SESJA9815
Sizes 14x16
Through 18x18
1
$118.00
Page: 37 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Jay Medical
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Foam Base With Flat Or Curved Bottom SESJA9820
Sizes 18x20
Through 20x20
1
$134.00
Foam Cushion 16x16, 16x18, 18x16,
18x18
SESJA8040
1
$191.00
Foam Cushion 17x16, 17x18
SESJA8057
1
$191.00
Foam Cushion 20x16
SESJA8055
1
$225.00
Foam Cushion 20x18
SESJA8050
1
$225.00
J-Gel Base
SESJA6830
1
$216.00
J-Gel Cushion 16" & 18" Deep
SESJA0700
1
$429.00
J-Gel Cushion 20" Deep
SESJA0705
1
$429.00
J2 Base Large Sizes
SESJA6810
1
$262.00
J2 Base Standard Sizes
SESJA6800
1
$207.00
J2 Cushions 18x16, 18x18 With
Standard Cover
SESJA0400
1
$546.00
J2 Deep Contour Cushion Standard
Sizes
SESJA0500
1
$571.00
J2 Deep Contour Cushion With Solid
Drop Seat Standard Sizes With Solid
Drop Seat
SESJA0600
1
$598.00
J2 Plus Cushion Foam Base
SESJA6835
1
$166.00
J2 Plus Cushion J2 Plus Cushion, Ae
Cover With Foam Kit
SESJA0750
1
$656.00
J2 Plus Cushion, Ae Cover With
Custom Foam Kit
SESJA0755
1
$690.00
J2 Plus Cushion, Ae Cover With Fluid
Pad
SESJA0760
1
$864.00
J2 Plus Cushion, Ls Inc. Cover With
Custom Foam Kit
SESJA0770
1
$692.00
J2 Plus Cushion, Ls Inc. Cover With
Fluid Pad
SESJA0775
1
$864.00
J2 Plus Cushion, Ls Inc. Cover With
Foam Kit
SESJA0765
1
$706.00
J2 Recline Cushions Standard Sizes
SESJA9500
1
$602.00
J3 Cushion J3 Cushion
SESJA0800
1
$700.00
Jay Active 18x16, 16x16, 14x16
SESJA2010
1
$606.00
Jay Active Foam Base 20" Deep
SESJA6325
1
$262.00
Jay Care Cushion 18x16, 18x8, 16x16,
16x18
SESJA5500
1
$406.00
Jay Combi Cushion 18x16 To 15.5x20
SESJA3010
1
$225.00
Jay Cushions 18x16, 15.5x16, 14x16
SESJA0010
1
$612.00
Jay Duo 16x16,16x18, 18x16, 18x18
Includes Solid Seat, 2 Covers &
Hardware
SESJA8005
1
$410.00
Page: 38 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Jay Medical
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Jay Easy Cushions Cushion With Flat
Or Curved Bottom Sizes 14x16
Through 18x18
SESJA9805
1
$449.00
Jay Fit Cushions Adjustable Contour
Seat For 10" Or 12" Frame Width,
Various Seat Depths
SESJA9700
1
$357.00
Jay G.S. Cushion
10x13,12x15,14x17,16x19,18x20
SESJA5000
1
$594.00
Jay Lite Cushion Jay Lite Cushion - All
Sizes
SESJA4200
1
$560.00
Jay Recliner Cushions 18x16, 18x18,
15.5x16, 15.5x18, 14x16
SESJA1010
1
$638.00
Jay Solution Jay Solution, Sizes 14 X
14 -17 X 18, Includes Cover
SESJA0360
1
$479.00
Jay Solution With Solid Drop Seat Jay
Solution With Solid Drop Seat, Sizes 14
X 14 - 18 X 20,
Includes Cover
SESJA0370
1
$636.00
Jay Solution With Solid Drop Seat,
Sizes 19 X 18 - 20 X 18,
Includes Cover
SESJA0375
1
$680.00
Jay Solution, Sizes 18 X 16 - 20 X 18,
Includes Cover
SESJA0365
1
$499.00
Jay Xtreme Cushion 14x14 To 18x18
With 2 Covers
SESJA9020
1
$496.00
Jay Zip Cushion Jay Zip, All Sizes
SESJA5550
1
$476.00
Large Adult 20x18
Includes Solid Seat, 2 Covers &
Hardware
SESJA8010
1
$455.00
Large Sizes
SESJA9510
1
$689.00
Narrow Pan 16x16, 16x18, 18x16,
18x18
Includes Cushion, 2 Covers &
Hardware
SESJA8020
1
$402.00
Narrow Pan 17x16, 17x18
Includes Solid Seat, 2 Covers &
Hardware
SESJA8027
1
$410.00
Narrow Pan 20x16 Includes Solid Seat,
2 Covers & Hardware
SESJA8025
1
$455.00
Narrow Pan 20x18
Includes Cushion, 2 Covers &
Hardware
SESJA8030
1
$455.00
Pressure Relief Pad With Air Exchange
Cover
SESJA5010
1
$689.00
Pressure Relief Pad With Incontinent
Cover
SESJA5005
1
$702.00
Page: 39 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Jay Medical
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Single Valve - W X D .gt.21 Inches Jay
3 Air Cushion -Width X Depth Greater
Than 21 Inches
SESJA9915
1
$872.00
Single Valve Jay 3 Air Cushion - Single
Valve
SESJA9905
1
$704.00
Sizes 18x16 To 10x10 With Air
Exchange Cover
SESJA0325
1
$638.00
Sizes 18x16 To 10x10 With Incontinent
Cover
SESJA0350
1
$626.00
Soft Combi With Lumbar Support
14x14, 12x12
SESJA3326
1
$177.00
Soft Combi With Lumbar Support
18x20, 16x20
SESJA3317
1
$208.00
Soft Combi With Lumbar Support 20x18 SESJA3316
1
$208.00
Soft Combi With Lumbar Support,
Narrow
Adult Soft 15.5x16
SESJA3320
1
$212.00
Soft Combi With Lumbar Support,
Regular
Adult Short 18x16
SESJA3310
1
$212.00
Soft Combi With Lumbar Support,
Regular Adult
SESJA3315
1
$212.00
Soft Combi Without Lumbar Support
14x14, 12x12
SESJA3346
1
$179.00
Soft Combi Without Lumbar Support
16x20, 18x20
SESJA3337
1
$179.00
Soft Combi Without Lumbar Support
20x18
SESJA3336
1
$179.00
Soft Combi Without Lumbar Support,
Narrow
Adult Short 15.5x16
SESJA3340
1
$179.00
Soft Combi Without Lumbar Support,
Narrow Adult 15.5x18
SESJA3345
1
$179.00
Soft Combi Without Lumbar Support,
Regular
Adult Short 18x16
SESJA3330
1
$179.00
Soft Combi Without Lumbar Support,
Regular
Adult Soft 18x18
SESJA3335
1
$179.00
Standard Sizes With Air Exchange
Cover
SESJA0440
1
$558.00
Standard Sizes With Incontinent Cover
SESJA0460
1
$550.00
Tlc Contoured Seat Cushion
SESKT2010
1
$1,148.00
Triad Standard Sizes
SESJA9105
1
$347.00
Xpress Standard Seat Cushion Specify Short (900020/1) Or Long
(900022/3)
SESKT2020
1
$200.00
Page: 40 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Kid Kart
Kids Up Inc
Lpa Medical
Inc.
Maple Leaf
Power Plus
Matrx Seating
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Xpress Contour Adjustable Cushion Specify Short (900312-28) Or Long
(900329-36)
SESKT2030
1
$404.00
Xpress Ledge Seat Cushion Specify Short (900028/9) Or Long
(900030/1)
SESKT2026
1
$370.00
Xpress Wedge Seat Cushion Specify Short (900024/5) Or Long
(900026/7)
SESKT2025
1
$76.00
Contoured Seat Cushion - All Sizes
SESK20005
1
$312.00
Xps Adaptive Seat Cushion
SESK20050
1
$312.00
Contour Seat Cushion With Perineal
Abductor
SESO12005
1
$108.00
Pre-Cure Cushion
SESO12010
1
$180.00
Contour Seat Cushion
SESWM0010
1
$208.00
Cozy Cushion Plus All Sizes
SESWM0050
1
$480.00
Cozy Cushion Plus Custom Sizes
SESWM0055
1
$640.00
Max Comfort Bariatric Cushion All Sizes SESWM0040
1
$784.00
Max Comfort Cushion All Sizes
SESWM0030
1
$624.00
Nylon/Leatherette 2" Foam Cushion
SESWM0001
1
$64.00
Nylon/Leatherette 3" Foam Cushion
SESWM0005
1
$72.00
11-12 Inches Wide To 20-21 Inches
Deep
SES1M0065
1
$443.00
23x30 Width To 21x30 Deep
SES1M0066
1
$796.00
Fits W/C 19"-22" Width & 16"-21" Depth
SES1M0010
1
$602.00
Fits W/C 20" - 24 Width & 20" - 22"
Depth
SES1M0040
1
$863.00
Fits W/C 20" Width & 16" - 18" Depth
SES1M0035
1
$733.00
Fits W/C 20" Width & 16"-19" Depth
SES1M1010
1
$714.00
Kidabra Base Fits W/C 12"-14" Width &
12"-15" Depth
SES1M2005
1
$677.00
Kidabra-V Cushion Fits W/C 11"-14"
Width & 12"-15" Depth
SES1M0015
1
$509.00
Matrx Flo-Tech Cushion Fits W/C 16" 19" Width & 16" - 21" Depth
SES1M0030
1
$639.00
Matrx Posture Seat Matrx Posture Seat, SES1M0060
All Sizes
1
$444.00
Matrx-V Base Fits W/C 16"-20" Width &
16"-19" Depth
SES1M1005
1
$677.00
Matrx-V Cushion Bariatric Sizes, Client
Weight
Exceeds 300lbs
SES1M0011
1
$742.00
Matrx-V Cushion Fits W/C 14"-18"
Width & 15"-21" Depth
SES1M0005
1
$551.00
Page: 41 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Matrx Seating
With Visco Foam Upgrade All Sizes
SES1M0070
1
$524.00
Motion
Concepts
Trx Onyx Seat 16-19" Width
SESZG0005
1
$644.00
Trx Onyx Seat 20-22" Width
SESZG0010
1
$695.00
Nighthawk
2" Bi-Medium Density Cumfy Cushion &
Base, Up To 18x18
SESNM8110
1
$236.00
2" Standard Foam With Cover
SESNM2000
1
$95.00
3" Medium Density Cumfy Cushion &
Base, Up To 18x18
SESNM8092
1
$230.00
3" Standard Foam With Cover
SESNM2010
1
$55.00
Aero Space Cushion, 16x16x3
SESNM9055
1
$352.00
Aero Space Cushion, 18x16x3
SESNM9060
1
$241.00
Aero Space Cushion, 18x18x3,20x16x3
SESNM9065
1
$248.00
Aero Space Cushion, 20x18x3
SESNM9070
1
$374.00
Afg Cushion 16x16, 16x18, 18x16,
18x18
SESNM1010
1
$347.00
Afg Cushion 20x16, 20x18
SESNM1020
1
$390.00
Bi-Hard Foam 2" Thru 4" With Cover
SESNM0150
1
$117.00
Bi-Med Foam 1" Thru 4" With Cover
SESNM0050
1
$261.00
Bi-Sunmate Cushion
SESNM6000
1
$307.00
Bi-Sunmate Cushion & Base
SESNM8070
1
$455.00
Contouring Arms Cushion & Base
SESNM8030
1
$250.00
Contouring Arms Deluxe Cushion &
Base
SESNM8020
1
$263.00
Cumfy Plus Cushion & Base
SESNM8060
1
$500.00
Cumfy Plus Cushion With Cover
SESNM4000
1
$316.00
Gel Suspension Cushion
16x16,18x16,18x18
SESNM9045
1
$298.00
Gel Suspension Cushion 20x16, 20x18
SESNM9050
1
$251.00
Gel-Mate, 18x16, 16x17
SESNM9035
1
$298.00
I.S.C.T-Bone Cushion With Cover
SESNM3000
1
$162.00
Med Foam 1" Thru 4" With Cover
SESNM0010
1
$256.00
Pocket-Mate, 18x16,16x18
SESNM9040
1
$120.00
Superior Cumfy Cushion & Base
SESNM8000
1
$550.00
Superior Cushion With Cover
SESNM2050
1
$431.00
Superior Thin Cumfy Cushion & Base
SESNM8010
1
$260.00
Superior Thin Cushion With Cover
SESNM2060
1
$356.00
Upcharge For Custom Sized Or
Oversized Cushions
SESNM0000
1
$49.00
Cushion With Contour Add Ons Non
Standard Sizes & Options
SESOF1010
1
$384.00
Orthofab
Page: 42 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Orthofab
Otto Bock
Permobil
Device
ADP Code
Max
Allowed
Qty.
Cushion With Ischial Elastomer Insert &
Contour Add Ons
14-20" Width & 15-20" Depth
SESOF1035
1
$544.00
Cushion With Ischial Elastomer Insert &
Contour Add Ons
15-18" Width & 15-20" Depth
SESOF1015
1
$426.00
Cushion With Ischial Elastomer Insert &
Contour Add Ons
Non Standard Sizes
SESOF1020
1
$480.00
Cushion With Ischial Elastomer Insert &
Contour Add Ons
Non Standard Sizes & Options
SESOF1040
1
$640.00
Cushion With Visco Foam Insert &
Contour Add Ons
Non Standard Sizes & Options
SESOF1030
1
$448.00
Iscus Cushions Cushion With Contour
Add Ons 15-18" Width & 15-20" Depth
SESOF1005
1
$324.00
Iscus Ii Cushions Cushion With Visco
Foam Insert & Contour Add Ons
14-20" Width & 15-20" Depth
SESOF1025
1
$368.00
Advantage Cushion All Sizes
SESOB704L
1
$444.00
Cloud Seat Cushion Standard Sizes
Smaller Than 16x17
SESOB6015
1
$489.00
Comfort Cushion Standard Sizes
SESOB8040
1
$627.00
Custom Sizes
SESOB6045
1
$641.00
Custom Sizes
SESOB8045
1
$810.00
Procontour Custom (Obss) Seat
Finished With Spray
Coating,Cover,Sewing Pattern
SESOB7100
1
$1,983.00
Seat-Itemized Cushion (Unfinished)
SESOB7105
1
$1,453.00
Sizes 16x18,17x16,17x17,18 X16
SESOB6020
1
$503.00
Sizes 17x18,18x17,18x18,19 X16
SESOB6025
1
$503.00
Sizes 19x18,20x16,20x18
SESOB6030
1
$517.00
Ergo Seat - All Sizes
SES1P0005
1
$407.00
SESWB0010
1
$1,711.00
Base Cushion Seat Vacuum Formed
Cover, Includes Labour
For Digitizing Or Plastering
SESWB0005
1
$1,439.00
Base Cushion Seat With All
Modifications, Includes
Labour For Digitizing Or Plastering
SESWB0015
1
$2,079.00
Precision-Fit Cushion Upcharge, Extra
Seat Depth 20"-24"
SESWB0024
1
$306.00
Precision-Fit Cushion Upcharge, Extra
Seat Width 20"-24"
SESWB0022
1
$306.00
Precision
Base Cushion Seat Sewn Cover
Rehab
Waterproof Foam, Includes
Manufacturing Labour For Digitizing Or Plastering
ADP
Approved
Amt.
Page: 43 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Max
Allowed
Qty.
ADP
Approved
Amt.
Precision
Precision-Fit Cushion, Subtle, Moderate SESWB0020
Rehab
Or Aggressive
Manufacturing Positioning. Includes Shape
Adjustments, Inner Cover, Outer
Cover And Cushion Rigidizer.
1
$1,079.00
Pride Mobility
Products
Quickie
Ride Designs
Roho
Device
ADP Code
Custom Sizes
SESX10020
1
$359.00
Sizes 20"X20" - 24"X24"
SESX10115
1
$639.00
Sizes 22" X 16" - 22" X 24"
SESX10095
1
$399.00
Sizes 22" X 20" - 24" X 24"
SESX10125
1
$496.00
Sizes 22" X 20" - 24" X 24"
SESX10135
1
$576.00
Synergy Simplicity Cushion All Sizes
SESX10080
1
$119.00
Synergy Solution Cushion Standard
Sizes
SESX10015
1
$319.00
Synergy Solution Sg Cushion Sizes 14"
X 14" - 20" X 18"
SESX10100
1
$215.00
Synergy Soluton Sg Cushion Sizes 20"
X 20" - 24" X 24"
SESX10105
1
$255.00
Synergy Spectrum Air Contoured
Cushion Sizes 14" X 12" - 20" X 24"
SESX10130
1
$544.00
Synergy Spectrum Air Cushion Sizes
14" X 12" - 20" X 24"
SESX10120
1
$464.00
Synergy Spectrum Cushion Viscoelastic SESX10025
Insert,Standard Sizes
1
$439.00
Synergy Structure 2 Cushion Sizes
14"X16" - 20"X18"
SESX10110
1
$599.00
Synergy Tru Comfort Cushion Sizes 16" SESX10090
X 14" - 20" X 24"
1
$319.00
Twin Cell Insert,Custom Sizes
SESX10040
1
$479.00
Twin Cell Insert,Standard Sizes
SESX10035
1
$439.00
Viscoelastic Insert,Custom Sizes
SESX10030
1
$479.00
2", 3" Or 4" Cushion With Cover
SESQU0355
1
$122.00
Contour Seat - Tilt Fx
SESQU0400
1
$392.00
Custom Cushions Standard (12-20"),
Extra Wide (21-22"), Custom Sizes.
Cover And Modifications Included.
SESR40005
1
$1,709.00
Ride Forward Cushion - All Sizes
SESR41020
1
$472.00
Airlite Cushion With Built In Cover All
Sizes
SESRO9005
1
$450.00
Contour Select Contour Select Cushion
Standard Sizes
SESRO9020
1
$719.00
Contour Select Cushion Custom Sizes
SESRO9025
1
$769.00
Custom Cushion Custom (Made To
Order) Cushion W/Cover
SESRO030L
2
$769.00
Custom Sizes Including Cover
SESRO2010
1
$739.00
Page: 44 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Roho
Star Cushion
Products Inc.
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Custom Sizes Including Cover
SESRO3010
1
$725.00
Custom Sizes Including Cover
SESRO3110
1
$725.00
Custom Sizes With Cover
SESRO6015
1
$609.00
Custom Sizes,Dual Valve,Cover
SESRO8010
1
$725.00
Dual Valve Hybrid Elite Cushion With
Cover Sizes 14x14 ,20x20
SESRO9503
1
$789.00
Dual Valve Hybrid Elite Cushion With
Cover, Sizes 22x18, 24x20
SESRO9504
1
$803.00
Enhancer Standard Adult & Paediatric
Sizes, Dual Valve, With Cover
SESRO8005
1
$650.00
Harmony Harmony Cushion With
Cover-Sizes 14x16, 20x18
SESRO9050
1
$499.00
High-Profile Cushions All Standard
Adult & Paediatric Sizes Including
Cover
SESRO3005
1
$650.00
Low Or High Profile Cushion Custom
Sizes With Cover
SESRO7040
1
$769.00
Low-Profile Cushions All Standard Adult SESRO3105
& Pediatric Sizes Including Cover
1
$650.00
Ltc Cushion, Including Cover
SESRO3015
1
$733.00
Ltc Cushion, Including Cover
SESRO3115
1
$733.00
Ltc Cushion, Including Cover
SESRO7055
1
$797.00
Mid-Profile Cushions All Standard Adult
& Paediatric Sizes Including Cover
SESRO2005
1
$659.00
Mini-Max Cushions Standard Sizes
(Does Not Include Cover)
SESRO4005
1
$595.00
Nexus Spirit Cushion With Cover
Standard Sizes
SESRO6010
1
$585.00
Quatro Select Cushions Low Or High
Profile Cushion With Cover Standard
Sizes
SESRO7035
1
$719.00
Single Valve Hybrid Elite Cushion With
Cover, Sizes 14x14 , 20x20
SESRO9501
1
$742.00
Single Valve Hybride Elite Cushion With SESRO9502
Cover, Sizes 22x18, 24x20
1
$756.00
Special Applicaton Cushions Adaptor
9x13x1" (Maximum 5)
SESRO1105
5
$209.00
Custom Cell Height Cushion Standard
Sizes
SESTJ0115
1
$644.00
Custom Sizes Over 22" In Two
Directions Width And Depth
SESTJ0110
1
$716.00
Custom Sizes Over 22" One Direction
Width Or Depth
SESTJ0105
1
$644.00
Galaxy Galaxy Cushion - All Sizes
SESTJ3005
1
$520.00
Page: 45 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Star Cushion
Products Inc.
Supracor
Tempur-Pedic
Medical
Wheelchair
Cushions
The Comfort
Company
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Mid Contour Cushion 3" Cells With
Cover
SESTJ0015
1
$496.00
Short Contour Cushion 2" Cells With
Cover
SESTJ0010
1
$496.00
Standard Contour Cushion 4" Cells
With Cover
SESTJ0005
1
$496.00
Starlock Cushion All Sizes 12x12
Through 22x22
SESTJ2005
1
$532.00
Bariatric Cushion (Classic) Clb 20-24"
SESRR0016
1
$756.00
Bariatric Cushion (Classic) Clb 25-28"
SESRR0017
1
$869.00
Bariatric Cushion (Classic) Clb 29-31"
SESRR0018
1
$1,040.00
Bariatric Cushion (Classic) Clb 32-35"
SESRR0019
1
$1,210.00
Classic Cushion 14x16-20x20
SESRR0010
1
$545.00
Classic Sling Bottom Cushion
14x16-20x20
SESRR0015
1
$567.00
Contoured Cushion 14x16-20x20
SESRR0020
1
$665.00
Contoured Sling Bottom Cushion
14x16-20x20
SESRR0025
1
$658.00
Corbee Cushion 10x10-14x14
SESRR0100
1
$343.00
Corbee Sling 10x10-14x14
SESRR0110
1
$371.00
Paediatric Contoured Cushion, Custom
Sizes
SESRR0065
1
$469.00
Paediatric Cushions Contoured
Cushion, Standard Sizes
SESRR0060
1
$637.00
Slimline Cushion 16x16-20x18
SESRR0030
1
$441.00
Slimline Sling Bottom Cushion
16x16-20x18
SESRR0035
1
$469.00
16"X16" Cushion - 3"Thickness
SEST20105
1
$194.00
18"X16" Cushion - 2"Thickness
SEST20010
1
$203.00
18"X16" Cushion - 3"Thickness
SEST20110
1
$228.00
18"X18" Cushion - 3"Thickness
SEST20115
1
$236.00
Curve Cushion, Stretch Air Or Fusion
Cover, All Sizes
SES7C0050
1
$134.00
Curve Cushion, Stretch Air Or Fusion
Cover, Custom Sizes
SES7C0055
1
$245.00
Hyalite Cushion, Condura Knit Or
Stretch Air
Cover, All Sizes
SES7C0030
1
$400.00
Hyalite Cushion, Condura Knit Or
Stretch Air
Cover, Custom Sizes
SES7C0035
1
$716.00
Maxx Cushion, Round Or Flat Bottom,
Fusion
Or Stretch Air Cover, All Sizes
SES7C0020
1
$514.00
Page: 46 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
ADP Code
Max
Allowed
Qty.
Maxx Cushion, Round Or Flat Bottom,
Fusion
Or Stretch Air Cover, Custom Sizes
SES7C0025
1
$907.00
Ridge Cushion, Stretch Air Or Fusion
Cover, All Sizes
SES7C0040
1
$487.00
Ridge Cushion, Stretch Air Or Fusion
Cover, Custom Sizes
SES7C0045
1
$894.00
Toronto
Orthopedic
Ltd.
Tops Seat Cushion (10" & 12" Width)
SESTP0005
1
$246.00
Trulife
Deep Comfort Cushion, All Sizes
SESCZ0110
1
$372.00
Gelcell Contour Cushion, All Sizes
SESCZ0080
1
$332.00
Gelcell Contour Plus, All Sizes
SESCZ0090
1
$381.00
Relax Duogel Contour Cushion, All
Sizes
SESCZ0040
1
$233.00
Relax Easy Cushion All Sizes
SESCZ0070
1
$233.00
Relax Gelcell, All Sizes
SESCZ0045
1
$319.00
Relax Trio Cushion, All Sizes
The Comfort
Company
Varilite
Medical
Products
Device
ADP
Approved
Amt.
SESCZ0035
1
$105.00
Evolution Bariatric Cushion Standard Or SESVP0408
Psv, All Sizes,
Includes Cover And Pressure Setting
Valve
1
$714.00
Evolution Cushion Standard Or Psv, All
Sizes,
Includes Cover And Pressure Setting
Valve
SESVP0406
1
$672.00
Evolution Wave Bariatric Cushion
Includes,
Cover And Positioning Base
SESVP0402
1
$817.00
Evolution Wave, All Sizes, Includes
Cover And Positioning Base
SESVP0401
1
$700.00
Meridian Bariatric Cushion, All Sizes,
Includes Cover
SESVP0605
1
$756.00
Meridian Cushion, All Sizes, Includes
Cover
SESVP0600
1
$630.00
Meridian Wave Bariatric Cushion, All
Sizes, Includes Cover
SESVP0615
1
$859.00
Meridian Wave Cushion, All Sizes,
Includes Cover
SESVP0610
1
$737.00
Proform Nx Cushion, Single, Dual, All
Sizes
Includes Cover
SESVP0351
1
$667.00
Reflex Cushion, All Sizes, Includes
Cover
SESVP6020
1
$397.00
Solo Cushion, Standard Or Psv, All
Sizes, Includes Cover
SESVP0200
1
$485.00
Page: 47 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Varilite
Medical
Products
Stratus Cushion, All Sizes, Includes
Cover
SESVP0410
1
$369.00
Zoid Cushion, All Sizes, Includes Cover
SESVP0500
1
$555.00
Vicair
Academy Adjuster
SESV10020
1
$630.00
Academy Junior Adjuster
SESV10010
1
$541.00
Academy Positioner Plus
SESV10015
1
$700.00
Academy Vector
SESV10025
1
$677.00
Liberty Pt
SESV10005
1
$467.00
Upcharge For Custom Sizes
SESV11005
1
$80.00
Comfort 2" Cushion Custom Sizes
SESVC5010
1
$421.00
Custom Base Custom Sizes Up To 19"
SESVC5050
1
$601.00
Custom Upcharge Upcharge For
Cushions Up To 20" X 19", Inclusive
SESVC4500
1
$227.00
Drop-Seat 18x18, 18x16, 16x16.5,
16x18
SESVC4160
1
$950.00
Drop-Seat 18x18, 18x16, 16x16.5,
16x18
SESVC4180
1
$995.00
Drop-Seat 18x18, 18x16,
16x16.5,16x18
SESVC4120
1
$919.00
Super Vantage Base Custom Sizes Up
To 19"
SESVC5060
1
$679.00
Super Vantage Base Standard Sizes
SESVC5055
1
$530.00
Super Vantage Custom Sizes Up To
19"
SESVC5030
1
$499.00
Super Vantage Special Edition Custom
Sizes Up To 19"
SESVC5040
1
$569.00
Super Vantage Special Edition
Standard Sizes
SESVC5035
1
$445.00
Super Vantage Standard Sizes
SESVC5025
1
$390.00
Upcharge For Cushions 20" - 24" Width
Or Depth Inclusive
SESVC4510
1
$327.00
Upcharge For Drop-Seats 20" - 24"
Width Or Depth Inclusive
SESVC4530
1
$342.00
Upcharge For Drop-Seats Up To 20" X
19", Inclusive
SESVC4520
1
$241.00
Vantage Bases Comfort Base Standard
Sizes
SESVC5045
1
$468.00
Vantage Comfort 2" Cushion Standard
Sizes
SESVC5005
1
$328.00
Very Soft - Deep Leg Troughs Sizes
18x18, 18x16, 16x16.5, 16x18
SESVC4100
1
$678.00
Very Soft Cushions Sizes 18x18,
18x16, 16x16.5, 16x18
SESVC4000
1
$684.00
Vision
Wheelchair
Seating
Systems Inc.
Page: 48 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
Device Type
Seat Cushion
Manufacturer
Vision
Wheelchair
Seating
Systems Inc.
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Very Soft Drop-Seat 18x18, 18x16,
16x16.5, 16x18
SESVC4030
1
$872.00
Very Soft Vive Cushions Sizes 18x18,
18x16, 16x16.5, 16x18
SESVC4150
1
$727.00
Very Soft Vive Deep Leg Troughs Sizes
18x18, 18x16, 16x16.5, 16x18
SESVC4170
1
$763.00
Page: 49 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
OPTIONS:
Device Type
Arm Support Hardware
Arm Support Options
Arm Support(s)
Manufacturer
ADP Code
Max
Allowed
Qty.
Approved
Non Standard Modular Mounting
ADP
Hardware
Manufacturers Required For Positioning (Maximum 2)
Only
SEAND0025
2
$160.00
Custom
Fabricated
SEICF301L
2
$70.00
Approved
Add Modular Pressure Relief To
ADP
Armrest Manufacturers Specialty Foam/Gel (Maximum 2)
Only
SEAND0030
2
$75.00
Custom
Fabricated
Options For Arm Supports Rigid Side
Panel For Custom Arm Support
(Maximum 2)
SEMCF601L
2
$60.00
Side Panel Pad For Custom Arm
Support
(Maximum 2)
SEMCF602L
2
$40.00
Extra Wide &/Or Extended Length For
SEAND0010
Modular Arm Supports Includes Mounting Hardware (Maximum
2)
2
$105.00
Modular Arm Support - Includes
Mounting Hardware (Maximum 2)
SEAND0005
2
$275.00
Modular Hand Support - Flat/Cone SEAND0015
Includes Mounting Hardware (Maximum
2)
2
$75.00
Complex Arm Support, Multi
Component,
Includes Hardware (Maximum 2)
SEACF102L
2
$250.00
Fixed Arm Support, One Piece,
Includes Hardware (Maximum 2)
SEACF101L
2
$150.00
Full Sling Arm Support,
Includes Hardware (Maximum 2)
SEACF104L
2
$300.00
Heavy Duty Solid Padded Armrest
Support,
Replaces Padded W/C Armpad,
Includes Hardware (Maximum 2)
SEACF103L
2
$75.00
Back Covers Removable Cover For Flat SEMCF101L
Back
2
$120.00
Removable Cover For Back With
Laterals
SEMCF103L
2
$230.00
Removable Cover For
Contoured/Custom Contoured Back
SEMCF102L
2
$180.00
Removable Cover For Sculptured Or
Molded Back
SEMCF104L
2
$270.00
Approved
ADP
Manufacturers
Only
Custom
Fabricated
Back Cover
Custom
Fabricated
Device
Armrest Hardware Swivel Armrest
Hardware (Maximum 2)
ADP
Approved
Amt.
Page: 50 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
OPTIONS:
Device Type
Back Hardware
Back Support Options
Foot/Leg Support Hardware
Foot/Leg Support Options
Foot/Leg Support(s)
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
Approved
ADP
Manufacturers
Only
Complex Specialized Mounting
Hardware - Including
Hardware For Custom Molded Modular
Systems Authorizer Must Provide Clinical
Rationale
SEBND0010
2
$400.00
Custom
Fabricated
Simple Back Interface Mounts Back To
Wheelchair Frame
SEICF160L
1
$195.00
Approved
Additional Pressure Relief - Gel/Air
ADP
Inserts/Pads Etc.
Manufacturers (Maximum 6)
Only
Custom Modifications And Sizing Including Custom Sizes,
Additional Postural Support - Lumbar
Pad, Foam Pads Etc.
(Maximum 6)
SEBND0020
6
$134.00
SEBND0015
6
$55.00
Custom
Fabricated
Back Channeling - Upgrade For Slots
For Lateral Adjustments
SEMCF201L
1
$150.00
Back Plaster Molding/Vacuum Form
SEUCF003L
1
$160.00
Back Reinforcement - Heavy Duty
Upgrade
SEMCF202L
1
$100.00
Options & Modifications For Backs
Modify Or Refurbish Existing Custom
Fabricated Back,
Includes Parts, Hardware & Labour
SEMCF200L
1
$225.00
Approved
ADP
Manufacturers
Only
Complex Specialized Mounting
Hardware Authorizer Must Provide Clinical
Rationale
SEFND0030
2
$100.00
Custom
Fabricated
Custom Upcharge For Footrests Mount
Footrest To Seating System
SEICF501L
2
$120.00
Approved
ADP
Manufacturers
Only
Extra Padding For Specific Pressure
Relief - (Maximum 2) Authorizer Must Provide Clinical
Rationale
SEFND0035
2
$50.00
Custom
Fabricated
Footrest Padding (Maximum2)
SEMCF803L
2
$60.00
Footrest Reinforcement Upcharge Heavy Duty
Upgrade To Reinforce Footrest
SEMCF802L
2
$140.00
Options For Footrests Footrest
Discrepancy Upcharge Accommodates Differences Between
Left & Right Leg
SEMCF801L
1
$80.00
SEFND0015
1
$110.00
SEFND0005
1
$285.00
Approved
1 Piece Foot Board - Includes Mounting
ADP
Hardware & Padding
Manufacturers
Amputee Board/Stump Support Only
Includes Mounting Hardware & Padding
ADP
Approved
Amt.
Page: 51 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
OPTIONS:
Device Type
Foot/Leg Support(s)
Headrest/Neckrest Hardware
Manufacturer
ADP Code
Max
Allowed
Qty.
Approved
Calf Panel - Includes Mounting
ADP
Hardware & Padding
Manufacturers
Foot Box - Includes Mounting Hardware
Only
& Padding Foot Box May Be 1 Piece Or 2 Piece
(Each Foot)
SEFND0010
2
$50.00
SEFND0020
2
$240.00
Custom
Fabricated
Calf Support, Padded And Removable
SEFCF107L
2
$195.00
Complex Foot Rest (One Or Two
Piece),
Includes Parts, Hardware, And Labour
SEFCF102L
1
$440.00
Footplate Extension, Not Padded
(Maximum 2)
SEFCF104L
2
$75.00
Footpocket, Not Padded ( Maximum 2)
SEFCF106L
2
$200.00
One Piece Double Footbox, Not
Padded
SEFCF103L
1
$297.00
One Piece Fixed Footrest,
Not Padded
SEFCF101L
1
$150.00
SEHND0020
1
$100.00
SEHND0015
1
$300.00
Modular Headrest Options Standard
Mounting Hardware Not Included In
Base Device Removable, Allows Height, Anterior &
Posterior Adjustments
SEHND0005
1
$140.00
Non Standard Mounting Hardware Not
Included In Base Device Removable, Allows Multi Axis
Adjustments
SEHND0010
1
$160.00
Complex Headrest Hardware, Allows
For Removability
& Height And Forward Adjustment
SEICF007L
1
$155.00
Headrest Hardware Simple Headrest
Hardware, Allows For Removability
& Height Adjustment
SEICF006L
1
$70.00
Multi-Axis Headrest Hardware, Allows
For Removability
And Multi Adjustments
SEICF008L
1
$261.00
Wheelchair Mounting Bracket For
Headrest Hardware
SEICF009L
1
$220.00
Complex Extension Pad, Mounted
(Maximum 2)
SEMCF006L
2
$300.00
Approved
Bracket To Mount Headrest To Seating
ADP
System/Back
Manufacturers Support Or Wheelchair
Only
Complex Specialized Mounting
Hardware Authorizer Must Provide Clinical
Rationale
Custom
Fabricated
Headrest/Neckrest Options
Device
Custom
Fabricated
ADP
Approved
Amt.
Page: 52 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
OPTIONS:
Device Type
Headrest/Neckrest Options
Lateral Support Hardware
Manufacturer
Custom
Fabricated
Custom
Fabricated
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Options For Headrest/Neckrest
Removable Headrest/Neckrest Cover,
Any Fabric, Use
For Flat/Contoured Headrest &
Neckrest
SEMCF001L
2
$120.00
Removable Cover For Complex
Headrests, Use For Complex
Headrest & Headrest/Neckrest
Combinations
SEMCF002L
2
$180.00
Simple Extension Pad, Mounted
(Maximum 2)
SEMCF005L
2
$200.00
Hinged Swingaway Lateral Hardware,
Height& Width Adjustable (Maximum 2)
SEICF202L
2
$200.00
Lateral Support Hardware Fixed Lateral
Hardware, Non-Adjustable (Maximum
2)
SEICF201L
2
$60.00
Removable Lateral Hardware,
SEICF203L
Height & Width Adjustable (Maximum 2)
2
$100.00
Lateral Support Options
Custom
Fabricated
Options For Lateral Supports Extra
Padding (Maximum 2)
SEMCF651L
2
$60.00
Lateral Support(s)
Approved
ADP
Manufacturers
Only
Complex Shape Lateral Supports, Each
Includes Padding & Mounting Hardware
(Maximum 4)
SELND0015
4
$192.50
Modular Lateral Support Options Fixed
Lateral Supports, Each Includes Padding & Mounting Hardware
(Maximum 4)
SELND0005
4
$120.00
Shoulder Wings, Each - Includes
Padding & Mounting Hardware
(Maximum 2)
SELND0020
2
$55.00
Swingaway Lateral Supports, Each Includes Padding & Mounting Hardware
(Maximum 4)
SELND0010
4
$180.00
Complex Shaped Thoracolumbar
Supports, Non Adjustable,
Includes Cover (Maximum 2)
SELCF102L
2
$175.00
Shoulder Wings, Non Adjustable,
Includes Cover
SELCF103L
2
$95.00
Thoracolumbar Supports, Rigid & Non
Adjustable,
Includes Cover (Maximum 2)
SELCF101L
2
$80.00
Hardware For Flip-Down Pommel
SEICF403L
1
$300.00
Hardware For Removable Pommel
SEICF402L
1
$175.00
Pommel Hardware Hardware For Fixed
Pommel
SEICF401L
1
$85.00
Custom
Fabricated
Pommel Hardware
Custom
Fabricated
Page: 53 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
OPTIONS:
Device Type
Pommel/Adductors
Positioning Belts
Manufacturer
ADP Code
Max
Allowed
Qty.
Approved
Pommel, Flip Down, All Components
ADP
Including Hardware
Manufacturers
Only
SESND1043
1
$300.00
Custom
Fabricated
Fixed Padded Adductor Includes Cover
(Maximum 2)
SEMCF702L
2
$120.00
Pommels & Adductors Custom Pommel
Without Hardware
SEMCF701L
1
$160.00
Removable Padded Adductor Includes
Cover
(Maximum 2)
SEMCF703L
2
$190.00
Any 2 Point Strap For Positioning Only - SERND0030
Any Closure Includes Padding & Mounting
Hardware -Chest, Hip,
Thigh, Calf, Ankle, Foot (Maximum 6)
6
$65.00
Any 4 Point Strap For Positioning Only - SERND0020
Any Closure Includes Padding & Mounting Hardware
Pelvic "Y" Strap, "H" Leg Strap
(Maximum 2)
2
$150.00
Chest Harness For Positioning Only Any Closure Includes Padding & Mounting Hardware
SERND0001
1
$140.00
Non Standard Chest Or Shoulder
Harness Required For
Positioning Support Only - Authorizer
Must Provide Clinical
Rationale To Support Request
SERND0035
1
$460.00
Shoulder Straps For Positioning Only Any Closure Includes Padding & Mounting Hardware
(Maximum 2)
SERND0010
2
$60.00
Custom Chest Support, Includes
Attachments
SERCF103L
1
$150.00
Custom Positioning Belt, Includes
Attachments.
Specify Upper &/Or Lower Extremity
&/Or Chest
(Maximum 12)
SERCF105L
12
$55.00
Custom Shoulder Harness, Includes
Padding & Attachments
SERCF104L
1
$210.00
Pelvic "Y" Belt Or Groin Strap, Includes
Attachments
SERCF101L
1
$60.00
Complex Control Pads (Maximum 4)
SEMCF503L
4
$165.00
Options For Belts Positioning Support
Pads (Maximum 12)
SEMCF501L
12
$55.00
Positioning Control Pads (Maximum 12)
SEMCF502L
12
$55.00
Approved
ADP
Manufacturers
Only
Custom
Fabricated
Positioning Belts Options
Custom
Fabricated
Device
ADP
Approved
Amt.
Page: 54 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
OPTIONS:
Device Type
SE - Custom Modifications
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
Approved
ADP
Manufacturers
Only
Custom Modifications To An Adp Listed
Modular Seating Device
& No Adp Code With Assigned Funding
Is Available Authorizer Must Provide Clinical
Rationale To Support
Request - Vendor Must Provide
Breakdown Of Cost Of Parts
& Labour (Not To Exceed $40.00/Hour)
SEMND2005
1
Seating Clinic Use Only Custom
Modifications Required To Adp Listed
Wheelchair To
Facilitate Installation Of Custom
Fabricated Positioning
Devices (Seating). Authorizer Must
Provide Clinical Rational
To Support Request. Clinic Must
Provide A Breakdown
Of The Cost Of Parts And Labour (Not
To Exceed $40.00/Hour).
SEMCF990L
1
Transfer Existing Adp Approved
Modular Seating System
Into New Or Modified Adp Approved
Wheelchair Labour Only, When No Parts Required
SEMND1005
1
$80.00
Transfer Existing Adp Approved
Custom Seating System
Into A New Or Modified Adp Approved
Wheelchair.
Labour Only, No Parts Required.
SEUCF200L
1
$80.00
Approved
Extra Cover Bariatric Sizes
ADP
Extra Cover Non Standard Sizes
Manufacturers
Only
Extra Cover Standard Sizes
SESND1060
1
$155.00
SESND1055
2
$115.00
SESND1050
2
$75.00
Custom
Fabricated
Removable Cover For Sculptured Or
Molded Seat,
For Incontinence (Maximum 2)
SEMCF107L
2
$250.00
Removable Cover For Wedged Or
Contoured Seat,
For Incontinence (Maximum 2)
SEMCF106L
2
$180.00
Seat Covers Removable Cover For Flat
Seat, For Incontinence
(Maximum 2)
SEMCF105L
2
$125.00
Approved
ADP
Manufacturers
Only
Complex Specialized Mounting
Hardware - Including
Hardware For Custom Molded Modular
Systems Authorizer Must Provide Clinical
Rationale To Support
Request
SESND1010
1
$300.00
Custom
Fabricated
Complex Interface Mounts Seat & Back
To Wheelchair Frame
SEICF170L
1
$350.00
Custom
Fabricated
Seat Cushion Cover(s)
Seat Hardware
ADP
Approved
Amt.
Page: 55 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
OPTIONS:
Device Type
Seat Hardware
Seat Options
Manufacturer
Custom
Fabricated
Device
Max
Allowed
Qty.
ADP
Approved
Amt.
Hardware To Mount Positioning Device
Into
Paediatric Stroller
SEICF190L
1
$100.00
Hardware To Mount Seat & Back Into
Dynamic Tilt Wheelchair
SEICF180L
1
$570.00
Seat & Back Hardware Strap Interface
(2) Mounts Seat To Wheelchair
SEICF140L
2
$100.00
Seat Rigidizer - Flat Rigid Insert
SEICF192L
1
$60.00
Securing Hardware That Mounts
Hardware To Mobility Device
(Maximum 8)
SEICF191L
8
$25.00
Simple Seat Interface Mounts Seat To
Wheelchair Frame
SEICF150L
2
$195.00
SESND1045
1
$415.00
SESND1040
6
$80.00
Drop Base And Hooks (4)
SESND1020
1
$250.00
Roho Bolster
SESND1035
1
$180.00
Solid Seat Insert
SESND1015
1
$80.00
Subasis Bar, Complete, Including
Hardware
SESND1041
1
$200.00
2" Convolute Foam Cut To Size
(Maximum 2)
SEMCF403L
2
$40.00
2" Polyfoam Cut To Size
(Maximum 2)
SEMCF406L
2
$30.00
3" Convolute Foam Cut To Size
(Maximum 2)
SEMCF404L
2
$45.00
3" Polyfoam Cut To Size
(Maximum 2)
SEMCF407L
2
$35.00
4" Convolute Foam Cut To Size
(Maximum 2)
SEMCF405L
2
$50.00
Add Waterproof Skin On Complex
Indirect Molded Seat
SEMCF210L
2
$100.00
Additional Foam Viscoelastic Foam Or
Pudgee 1" Thick/1 Square Foot
(Maximum 2)
SEMCF401L
2
$60.00
Complex Pelvic Stabilizers, Each
(Maximum 2)
SEMCF206L
2
$225.00
Approved
Additional Pressure Relief - Specialty
ADP
Foam, Air, Gel
Manufacturers
Custom Modifications And Sizing Only
Including Custom Sizes,
Static Adductors & Pommels, Wedges
& Anti-Thrust
Devices, Leg Length Discrepancy
Allowance (Maximum 6).
Custom
Fabricated
ADP Code
Page: 56 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
OPTIONS:
Device Type
Seat Options
Tray
Manufacturer
Custom
Fabricated
Approved
ADP
Manufacturers
Only
Custom
Fabricated
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Contoured Cushion With Troughing
Secured In Front Of A Roho
Cushion, Not Including Roho Cushion,
Includes Cover
SEMCF209L
1
$380.00
Heavy Duty Upgrade To Reinforce Seat
SEMCF207L
1
$75.00
Modify Or Refurbish Existing Custom
Fabricated Seat,
Includes Parts, Hardware & Labour
SEMCF212L
1
$225.00
Options & Modifications For Seats
Upgrade To Provide Extra Pressure
Relief,
Gel/Foam/Air/Liquid Etc. (Maximum 2)
SEMCF203L
2
$150.00
Pelvic Stabilizer (Maximum 2)
SEMCF204L
2
$214.00
Polymer Supplement Pad
(Maximum 2)
SEMCF402L
2
$150.00
Seat Plaster Molding/Vacuum Form
SEUCF005L
1
$160.00
Simple Cushion Secured In Front Of A
Roho Cushion,
Not Including Roho Cushion, Includes
Cover
SEMCF208L
1
$200.00
Single Complex Pelvic Stabilizer For
Seat Or Back
SEMCF205L
1
$300.00
Full Tray For Positioning Support Only Standard
Adult & Paediatric Sizes, Includes
Mounting Hardware
SETND0005
1
$190.00
Full Tray Non Standard Size For
Positioning Support Only Adult & Paediatric Sizes, Includes
Mounting Hardware
SETND0010
1
$325.00
Half Tray For Positioning Support Only - SETND0020
Non Standard
Adult & Paediatric Sizes, Includes
Mounting Hardware
2
$315.00
Half Tray For Positioning Support Only - SETND0015
Standard
Adult & Paediatric Sizes, Includes
Mounting Hardware
2
$235.00
Customized Lexan Tray, Includes
Mounting Hardware
SETCF103L
1
$420.00
Kydex Tray, Includes Mounting
Hardware
SETCF104L
1
$360.00
Plastic Tray, Includes Mounting
Hardware
SETCF101L
1
$350.00
Wood/Arborite Tray, Includes Mounting
Hardware
SETCF102L
1
$255.00
Page: 57 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Seating
OPTIONS:
Device Type
Tray Options
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
Approved
Add Modular Elbow Or Hip Blocks To
ADP
Any Modular Tray Manufacturers (Maximum 4)
Only
Add Padding To Any Tray
SETND0030
4
$65.00
SETND0035
2
$75.00
Custom
Fabricated
Elbow Block Padding Including Cover
(Maximum 2)
SEMCF306L
2
$60.00
Elbow Blocks (Maximum 2)
SEMCF305L
2
$85.00
Large/Full Tray Pad (Maximum 2)
SEMCF304L
2
$145.00
Options & Modifications For Trays Clear SEMCF301L
Tray Cover, Removable
1
$80.00
Small Tray Pad (Maximum 2)
2
$80.00
SEMCF303L
ADP
Approved
Amt.
Page: 58 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Manual)
Device Type
Adult High Performance Rigid Manual
Wheelchair
Wheelchair type offers lightweight rigid frame
and optimal maneuverability. Suitable for the
very active user who requires postural support
and altered wheel placement for mobility. ADP
price includes frame (sizes up to 18"wide x
18"deep), standard upholstery, swing away
detachable footrests, height adjustable
armrests, rear anti-tippers, 2 point seat belt any
closure, brake extensions, front casters,
wheels. See Manual Wheelchair Options Chart
for other basic components funded by ADP.
Adult Lightweight Performance
Manual Wheelchair
Wheelchair type offers maximum adjustments
and options. Suitable for the very active user
who requires altered wheel placement for
optimal postural support and mobility. ADP
price includes frame (sizes up to 18"wide x
18"deep), standard upholstery, swing away
detachable footrests, height adjustable
armrests, rear anti-tippers, 2 point seat belt any
closure, brake extensions, front casters,
wheels. See Manual Wheelchair Options Chart
for other basic components funded by ADP.
Manufacturer
Invacare
Device
ADP Code
Max Allowed
Qty.
ADP Approved
Amt.
A-4
WMA4IN015
1
$3,592.00
Crossfire T6/Ti
WMA4IN110
1
$3,592.00
Crossfire T7a
WMA4IN130
1
$3,592.00
Terminator
WMA4IN105
1
$3,592.00
Ki Mobility
Tsunami
WMA4KI015
1
$3,592.00
Quickie
Quickie Gp/Gpv
WMA4QU005
1
$3,592.00
Quickie Gt
WMA4QU030
1
$3,592.00
Quickie Gti
WMA4QU035
1
$3,592.00
Quickie Q7
WMA4QU040
1
$3,592.00
Quickie Ti
WMA4QU020
1
$3,592.00
Quickie Xtr
WMA4QU010
1
$3,592.00
Rgk Wheelchairs
Hi-Lite
WMA4RZ005
1
$3,592.00
Rogue Wheels
Inc.
Marvel
WMA4M0005
1
$3,592.00
Tisport
Tilite Aero Z
WMA4TZ010
1
$3,592.00
Tilite Yr/Tr,Yra/Tra,Trc,Zra
WMA4TZ005
1
$3,592.00
Galaxy Lite
WMA3FM010
1
$2,655.00
Future Mobility
Northern Lite
WMA3FM005
1
$2,655.00
Handicare
Legend 2 Exigo/Exigo
WMA3M9015
1
$2,655.00
Invacare
Compass Xe (Allegro)
WMA3IN030
1
$2,655.00
Mvp
WMA3IN060
1
$2,655.00
Myon Active
WMA3IN065
1
$2,655.00
Prospin X4
WMA3IN035
1
$2,655.00
Xtra
WMA3IN005
1
$2,655.00
Catalyst 5, 5ti
WMA3KI010
1
$2,655.00
Catalyst 5vx
WMA3KI015
1
$2,655.00
Maple Leaf
Power Plus
Ez Ride
WMA3WM005
1
$2,655.00
Motion
Composites
Helio
WMA3QM005
1
$2,655.00
Orthofab
Prima
WMA3OF010
1
$2,655.00
Otto Bock
Motus
WMA3OB010
1
$2,655.00
Start M5 Comfort
WMA3OB005
1
$2,655.00
Pride Mobility
Products
Litestream Xf
WMA3X1010
1
$2,655.00
Product Design
Group
Eclipse 600
WMA3MV005
1
$2,655.00
Quickie
Quickie 2
WMA3QU005
1
$2,655.00
Quickie 2 Hp
WMA3QU010
1
$2,655.00
Quickie 2 Lite
WMA3QU020
1
$2,655.00
Quickie Gtx
WMA3QU040
1
$2,655.00
Ki Mobility
Page: 59 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Manual)
Device Type
Adult Lightweight Performance
Manual Wheelchair
Wheelchair type offers maximum adjustments
and options. Suitable for the very active user
who requires altered wheel placement for
optimal postural support and mobility. ADP
price includes frame (sizes up to 18"wide x
18"deep), standard upholstery, swing away
detachable footrests, height adjustable
armrests, rear anti-tippers, 2 point seat belt any
closure, brake extensions, front casters,
wheels. See Manual Wheelchair Options Chart
for other basic components funded by ADP.
Adult Lightweight Standard Manual
Wheelchair
Wheelchair type most suitable for user who is
independently mobile and requires some
adjustments to accommodate postural and
mobility requirements. ADP price includes
frame (sizes up to 18"wide x 18"deep),
standard upholstery, swing away detachable
footrests, height adjustable armrests, rear antitippers, 2 point seat belt any closure, brake
extensions, front casters, wheels. See Manual
Wheelchair Options Chart for other basic
components funded by ADP.
Manufacturer
ADP Code
Max Allowed
Qty.
Quickie Lxi
WMA3QU405
1
$2,655.00
Quickie M6
WMA3QU420
1
$2,655.00
Quickie Revolution
WMA3QU410
1
$2,655.00
Rgk Wheelchairs
Maxima
WMA3RZ005
1
$2,655.00
Tisport
Tilite X, Sx, Tx
WMA3TZ005
1
$2,655.00
Future Mobility
Stellato
WMA2FM005
1
$1,680.00
Invacare
9000 Sl
WMA2IN030
1
$1,680.00
9000 Topaz
WMA2IN055
1
$1,680.00
9000 Xt
WMA2IN025
1
$1,680.00
Myon Manual Wheelchair
WMA2IN060
1
$1,680.00
Quickie
Device
ADP Approved
Amt.
Patriot
WMA2IN050
1
$1,680.00
Ki Mobility
Catalyst 4, 4c
WMA2KI010
1
$1,680.00
Maple Leaf
Power Plus
Nrg+
WMA2WM005
1
$1,680.00
Swift
WMA2WM010
1
$1,680.00
Orthofab
Ch+
WMA2OF005
1
$1,680.00
Otto Bock
Start M2 Effect
WMA2OB005
1
$1,680.00
Pride Mobility
Products
Litestream Xf Ltd
WMA2X1010
1
$1,680.00
Stylus 400
WMA2X1005
1
$1,680.00
Quickie
Breezy 600
WMA2QU001
1
$1,680.00
Breezy Ultra 4
WMA2QU010
1
$1,680.00
Quickie Lx
WMA2QU105
1
$1,680.00
Adult Manual Dynamic Tilt Wheelchair Advanced
Ams Itilt2
WMA5AO020
1
$2,446.00
Wheelchair type offers manual dynamic tilt
required by the user who can not maintain an
upright posture through the use of seating
components alone. ADP price includes dynamic
tilt frame (sizes up to 18" wide x 18"deep),
standard upholstery, swing away detachable
footrests, height adjustable armrests, rear antitippers, brake extensions, 2 point seat belt any
closure, front casters, wheels. See Manual
Wheelchair Options Chart for other basic
components funded by ADP.
Tilt Recline/ I Tilt
WMA5AO015
1
$2,446.00
Cat 587
WMA5B-025
1
$2,446.00
Elite 785
WMA5B-020
1
$2,446.00
Models 80 & 48
WMA5B-005
1
$2,446.00
Models 85 & 35 & 75
WMA5B-010
1
$2,446.00
Orion 500
WMA5FM010
1
$2,446.00
Orion Ii
WMA5FM005
1
$2,446.00
Emineo
WMA5M9010
1
$2,446.00
Ibis
WMA5M9005
1
$2,446.00
Concept 45
WMA5IN020
1
$2,446.00
Htr
WMA5IN025
1
$2,446.00
Solara 2g
WMA5IN035
1
$2,446.00
Solara 3g
WMA5IN040
1
$2,446.00
Comp-Position
WMA5LQ010
1
$2,446.00
Mobility
Broda
Future Mobility
Handicare
Invacare
Lpa Medical Inc
Page: 60 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Manual)
Device Type
Manufacturer
Device
ADP Code
Max Allowed
Qty.
ADP Approved
Amt.
Adult Manual Dynamic Tilt Wheelchair Lpa Medical Inc
Dyn-Ergo
WMA5LQ020
1
$2,446.00
Wheelchair type offers manual dynamic tilt
required by the user who can not maintain an
upright posture through the use of seating
components alone. ADP price includes dynamic
tilt frame (sizes up to 18" wide x 18"deep),
standard upholstery, swing away detachable
footrests, height adjustable armrests, rear antitippers, brake extensions, 2 point seat belt any
closure, front casters, wheels. See Manual
Wheelchair Options Chart for other basic
components funded by ADP.
Evolution
WMA5LQ015
1
$2,446.00
Optimum Posturo-Pedic
WMA5LQ005
1
$2,446.00
Mlt 700a/B
WMA5WM015
1
$2,446.00
Mltr 500 & 600
WMA5WM010
1
$2,446.00
Maple Leaf
Power Plus
Supertilt
WMA5WM005
1
$2,446.00
Orthofab
Tango
WMA5OF005
1
$2,446.00
Product Design
Group
Astrotilt
WMA5MV015
1
$2,446.00
Bentley
WMA5MV005
1
$2,446.00
Fuze T20
WMA5MV025
1
$2,446.00
Fuze T50
WMA5MV020
1
$2,446.00
Stellar
WMA5MV010
1
$2,446.00
Quickie Iris
WMA5QU015
1
$2,446.00
Quickie Ts
WMA5QU005
1
$2,446.00
Tilt Fx
WMA5QU020
1
$2,446.00
Quickie
Adult Standard Manual Wheelchair
Amg Medical
Airgo
WMA1GM005
1
$1,424.00
Wheelchair type most suitable for user who is
not consistently independently mobile and
requires minimal adjustments to accommodate
postural and mobility requirements. ADP price
includes frame (sizes up to 18"wide x 18"deep),
standard upholstery, swing away detachable
footrests, height adjustable armrests, rear antitippers, 2 point seat belt any closure, brake
extensions, front casters, wheels. See Manual
Wheelchair Options Chart for other basic
components funded by ADP.
Broda
48/Runabout
WMA1B-015
1
$1,424.00
Everest &
Jennings
Traveler
WMA1EJ005
1
$1,424.00
Invacare
900
WMA1IN015
1
$1,424.00
Tracer
WMA1IN005
1
$1,424.00
Quickie
Easy Care 2000 & 4000
WMA1QU015
1
$1,424.00
Paediatric High Performance Rigid
Manual Wheelchair
Invacare
Comet
WMK4IN020
1
$3,889.00
Crossfire T6a
WMK4IN130
1
$3,889.00
Ki Mobility
Tsunami
WMK4KI005
1
$3,889.00
Quickie
Quickie Gp
WMK4QU010
1
$3,889.00
Quickie Gt
WMK4QU030
1
$3,889.00
Quickie Q7
WMK4QU035
1
$3,889.00
Quickie Ti
WMK4QU025
1
$3,889.00
Zippie
WMK4QU005
1
$3,889.00
Zippie Zone
WMK4QU040
1
$3,889.00
Rgk Wheelchairs
Hi-Lite
WMK4RZ005
1
$3,889.00
Tisport
Tilite Aero Z
WMK4TZ010
1
$3,889.00
Tilite Yr/Tr,Yra/Tra,Trc,Zra
WMK4TZ005
1
$3,889.00
Wheelchair type offers lightweight rigid frame
and optimal maneuverability. Suitable for the
very active user who requires postural support
and altered wheel placement for mobility. ADP
price includes frame (sizes up to 16"wide x
16"deep), standard upholstery, swing away
detachable footrests, height adjustable
armrests, rear anti-tippers, 2 point seat belt any
closure, brake extensions, front casters,
wheels. See Manual Wheelchair Options Chart
for other basic components funded by ADP.
Page: 61 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Manual)
Device Type
Paediatric Lightweight Performance
Manual Wheelchair
Wheelchair type offers maximum adjustments
and options. Suitable for the active user who
requires altered wheel placement for optimal
postural support and mobility. ADP price
includes frame (sizes up to 16"wide x 16"deep),
standard upholstery, swing away detachable
footrests, height adjustable armrests, rear antitippers, 2 point seat belt any closure, brake
extensions, front casters, wheels. See Manual
Wheelchair Options Chart for other basic
components funded by ADP.
Manufacturer
Invacare
Device
ADP Code
Max Allowed
Qty.
ADP Approved
Amt.
Compass Xe (Allegro)
WMK3IN020
1
$2,678.00
Mvp Junior
WMK3IN030
1
$2,678.00
Myon Jr Manual
Wheelchair
WMK3IN040
1
$2,678.00
Prospin X4
WMK3IN035
1
$2,678.00
Otto Bock
Motus
WMK3OB005
1
$2,678.00
Quickie
Quickie 2
WMK3QU010
1
$2,678.00
Quickie 2 Hp
WMK3QU015
1
$2,678.00
Quickie 2 Lite
WMK3QU020
1
$2,678.00
Quickie Gtx
WMK3QU040
1
$2,678.00
Quickie Lxi
WMK3QU030
1
$2,678.00
Zippie 2
WMK3QU005
1
$2,678.00
Zippie Gs
WMK3QU035
1
$2,678.00
Rgk Wheelchairs
Maxima
WMK3RZ005
1
$2,678.00
Tisport
Tilite X, Sx, Tx
WMK3TZ005
1
$2,678.00
Paediatric Lightweight Standard
Manual Wheelchair
Handicare
Legend 2 Exigo/Exigo
WMK2M9020
1
$1,850.00
Wheelchair type most suitable for user who
requires some adjustments to accommodate
postural and mobility requirements. ADP price
includes frame (sizes up to 16"wide x 16"deep),
standard upholstery, swing away detachable
footrests, height adjustable armrests, rear antitippers, 2 point seat belt any closure, brake
extensions, front casters, wheels. See Manual
Wheelchair Options Chart for other basic
components funded by ADP.
Invacare
9000 Jymni
WMK2IN010
1
$1,850.00
Pride Mobility
Products
Litestream Xf
WMK2X1010
1
$1,850.00
Quickie
Quickie Lx
WMK2QU020
1
$1,850.00
Paediatric Manual Dynamic Tilt
Wheelchair
Convaid
Cuddlebug
WMK5CO050
1
$3,251.00
Wheelchair type offers manual dynamic tilt
required by the user who can not maintain an
upright posture through the use of seating
components alone. ADP price includes dynamic
tilt frame (sizes up to 16" wide x 16"deep),
standard upholstery, swing away detachable
footrests, height adjustable armrests, rear antitippers, brake extensions, 2 point seat belt any
closure, front casters, wheels. See Manual
Wheelchair Options Chart for other basic
components funded by ADP.
Safari Tilt
WMK5CO040
1
$3,251.00
Future Mobility
Super Chair For Kids
WMK5FM010
1
$3,251.00
Invacare
Orbit/Tiger
WMK5IN010
1
$3,251.00
Spree 3g
WMK5IN030
1
$3,251.00
Spree Gt
WMK5IN025
1
$3,251.00
Spree Xt
WMK5IN020
1
$3,251.00
Kid Kart Xpress
WMK5KT020
1
$3,251.00
Kid-Tlc
WMK5KT010
1
$3,251.00
Bingo
WMK5K2010
1
$3,251.00
F.A.S.T
WMK5K2015
1
$3,251.00
Kid Kart
Kids Up Inc
Kids Rock
WMK5K2005
1
$3,251.00
Otto Bock
Kimba Spring & Kimba
Spring Plus
WMK5OB010
1
$3,251.00
Product Design
Group
Astrotilt Jr.
WMK5MV015
1
$3,251.00
Fuze T20
WMK5MV025
1
$3,251.00
Fuze T50
WMK5MV020
1
$3,251.00
Page: 62 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Manual)
Device Type
ADP Code
Max Allowed
Qty.
Zippie Iris
WMK5QU010
1
$3,251.00
Zippie Ts
WMK5QU005
1
$3,251.00
Specmat
Technologies
Chunc 45
WMK51S005
1
$3,251.00
Paediatric Specific Specialty Stroller
Alvema
Series 100/Pix1
WMK6AL005
1
$1,511.00
ADP price includes stroller frame and
upholstery, foot support, seat and back
supports, headrest, chest and pelvic positioning
straps (harness), abductor, and wheels. See
Manual Wheelchair Options Chart for additional
basic components funded by ADP.
Convaid
Convertible
WMK6CO070
1
$1,511.00
Cruiser Cx & Cr
WMK6CO005
1
$1,511.00
Ez Rider
WMK6CO050
1
$1,511.00
Metro
WMK6CO030
1
$1,511.00
Rodeo Tilt
WMK6CO060
1
$1,511.00
Scout
WMK6CO025
1
$1,511.00
Maclaren
Buggy
WMK6AM005
1
$1,511.00
Otto Bock
Eco-Buggy
WMK6OB005
1
$1,511.00
Paediatric Manual Dynamic Tilt
Wheelchair
Wheelchair type offers manual dynamic tilt
required by the user who can not maintain an
upright posture through the use of seating
components alone. ADP price includes dynamic
tilt frame (sizes up to 16" wide x 16"deep),
standard upholstery, swing away detachable
footrests, height adjustable armrests, rear antitippers, brake extensions, 2 point seat belt any
closure, front casters, wheels. See Manual
Wheelchair Options Chart for other basic
components funded by ADP.
Manufacturer
Quickie
Device
ADP Approved
Amt.
Page: 63 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Manual)
OPTIONS:
Device Type
Manufacturer
Device
ADP Code
Max Allowed
Qty.
ADP Approved
Amt.
Adjustable Tension Back Upholstery
over 18" Frame Width
WAME
1
$240.00
Adjustable Tension Back Upholstery
up to 18" Frame Width
WAMD
1
$140.00
Amputee Axle Plates (pair)
WAMT
1
$113.00
Angle Adjustable Footplates (pair)
WAMJ
1
$130.00
Caster Pin Locks (pair)
WAMS
1
$171.00
Clothing Guards
WAMV
1
$126.00
Elevating Legrests (pair)
WAMK
1
$404.00
Grade Aids (pair)
WAMR
1
$116.00
Heavy Duty Cross Braces &
Upholstery
WAMC
1
$680.00
Heavy Duty Model, Client Weight
Exceeds 250 Lbs
WAMF
1
$730.00
WAMG
1
$992.00
WAMH
1
$1,110.00
Hub-Eez Easy Push Wheel
WAMM
1
$716.00
MW - Custom Modifications
MWCM
1
One Arm/Lever Drive
WAML
1
$1,046.00
Oxygen Tank Holder
WAMX
1
$195.00
Plastic Coated Handrims
WAMO
1
$134.00
HEAVY DUTY MODEL REQUIRED, CLIENT
WEIGHT EXCEEDS 250LBS. Authorizer must
document client weight. Selected device must
meet weight requirements.
Heavy Duty Model, Client Weight
Exceeds 350 Lbs
HEAVY DUTY MODEL REQUIRED, CLIENT
WEIGHT EXCEEDS 350LBS. Authorizer must
document client weight. Selected device must
meet weight requirements.
Heavy Duty Model, Client Weight
Exceeds 400 Lbs
HEAVY DUTY MODEL REQUIRED, CLIENT
WEIGHT EXCEEDS 400LBS. Authorizer must
document client weight. Selected device must
meet weight requirements.
Page: 64 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Manual)
OPTIONS:
Device Type
Manufacturer
Device
ADP Code
Max Allowed
Qty.
ADP Approved
Amt.
Dolomite
Alber E.Motion
WPS1DO005
1
$6,135.00
Magicwheels
Magicwheels
WPS1WS005
1
$6,135.00
Quickie
Quickie Xtender
WPS1QU005
1
$6,135.00
Projected Handrims (pair)
WAMQ
1
$224.00
Quick Release Axles (pair)
WAMU
1
$110.00
Recliner Option
WAMI
1
$527.00
Seat Depth Required is Greater Than
18"
WAMB
1
$265.00
Seat Width Required is Greater Than
18"
WAMA
1
$399.00
Spoke Protectors (pair)
WAMP
1
$116.00
Standard Manual Wheelchair Frame
with Manual Dynamic Tilt *
WANA
1
$1,200.00
Stroller Handles/Paediatric
WAMW
1
$147.00
Titanium Frame *
WAMZ
1
$1,500.00
Uni-Lateral Wheel Lock
WAMN
1
$149.00
Ventilator Tray
WAMY
1
$425.00
Power Add-On Device
Device is added onto a manual wheelchair to
assist the user meet their long term basic and
essential mobility requirements. User must be
able to operate the manual wheelchair
independently. This code may be used only
when it is not anticipated that the user will
require the use of a power wheelchair to meet
their long term basic and essential mobility
requirements. ADP funding assistance is not
provided for a power add on device and a
power wheelchair.
STANDARD MANUAL WHEELCHAIR WITH
MANUAL DYNAMIC TILT (WMA5, WMK5).
Frame offers ongoing adjustability and
facilitates independent mobility. Authorizer must
provide clinical rationale to support the request.
Selected device must meet clinical
requirements.
TITANIUM FRAME MANUAL WHEELCHAIR,
ADP TYPE 3 & TYPE 4. Authorizer must
provide clinical rationale to support the request.
Selected device must meet clinical
requirements.
Page: 65 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Power)
Device Type
Adult Power Base Type 1
Wheelchair type most suitable for use on hard,
flat surfaces. Primarily for user who requires
minimal adjustments to support independent
mobility. ADP price includes seat and back
frame (sizes up to 18" wide x 18"deep),
standard joystick control, swing away
detachable footrests, height adjustable
armrests, 2 point seat belt any closure, front
casters, wheels. See Power Wheelchair
Options Chart for other basic components
funded by ADP.
Adult Power Base Type 2
Wheelchair type suitable for use on most
surfaces. Primarily for user who requires
postural support, modifications to electronics,
and other specific options to support
independent mobility. ADP price includes seat
and back frame (sizes up to 18" wide x
18"deep), standard joystick control, swing away
detachable footrests, height adjustable
armrests, 2 point seat belt any closure, front
casters, and wheels. See Power Wheelchair
Options Chart for other basic components
funded by ADP.
Adult Power Base Type 3
Wheelchair type suitable for use on most
surfaces. Primarily for the user who requires
ongoing changes in postural support,
modifications to electronics, and other specific
options to support independent mobility. ADP
price includes base, 2 point seat belt any
closure and standard joystick control. See
Power Wheelchair Options Chart for other basic
components funded by ADP.
Manufacturer
Invacare
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Nutron Series R51lxp
WPA1IN065
1
$5,092.00
Pronto M51
WPA1IN075
1
$5,092.00
Maple Leaf
Power Plus
Mp1
WPA1WN005
1
$5,092.00
Pride
Mobility
Products
Jazzy 1103 Ultra
WPA1X1020
1
$5,092.00
Jazzy Select 14 / Select 14 Plus
WPA1X1015
1
$5,092.00
Jazzy Select 6
WPA1X1230
1
$5,092.00
Jet 3 Ultra
WPA1X1030
1
$5,092.00
Quickie
Quickie V-121
WPA1QU020
1
$5,092.00
Shoprider/
Pihsiang
Shoprider P424l
WPA1S7015
1
$5,092.00
Shoprider P424m
WPA1S7010
1
$5,092.00
Spitfire 888wa
WPA1S7005
1
$5,092.00
Invacare
3g Ranger X Storm Series
WPA2IN040
1
$6,738.00
Maple Leaf
Power Plus
Mp2
WPA2WN005
1
$6,738.00
Pride
Mobility
Products
Jazzy 600
WPA2X1220
1
$6,738.00
Quickie
Quickie V-521
WPA2QU405
1
$6,738.00
Future
Mobility
Orion Explorer Magellan
WPA3FM005
1
$7,101.00
Orion Explorer Viking
WPA3FM010
1
$7,101.00
Handicare
Alex Power Wheelchair
WPA3M9005
1
$7,101.00
Invacare
Action Torque Storm
WPA3IN015
1
$7,101.00
Arrow Storm Rwd
WPA3IN020
1
$7,101.00
Fdx
WPA3IN080
1
$7,101.00
Pronto M91
WPA3IN050
1
$7,101.00
Pronto M94
WPA3IN052
1
$7,101.00
Tdx Sp/Sr
WPA3IN070
1
$7,101.00
Tdx-Sc
WPA3IN075
1
$7,101.00
Maple Leaf
Power Plus
Mp5
WPA3WM005
1
$7,101.00
Orthofab
Oasis
WPA3OF110
1
$7,101.00
Permobil
C300
WPA31P010
1
$7,101.00
C350
WPA31P030
1
$7,101.00
C400
WPA31P015
1
$7,101.00
C500
WPA31P020
1
$7,101.00
Chairman Hd3
WPA31P025
1
$7,101.00
Street
WPA31P005
1
$7,101.00
Page: 66 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Power)
Device Type
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Jazzy/Quantum 1113
WPA3X1100
1
$7,101.00
Jazzy/Quantum 1121
WPA3X1110
1
$7,101.00
Jazzy/Quantum 1170
WPA3X1010
1
$7,101.00
Jazzy/Quantum 1402 & 1420
WPA3X1020
1
$7,101.00
Jazzy/Quantum 1650
WPA3X1230
1
$7,101.00
Quantum 600
WPA3X1220
1
$7,101.00
Quantum 6000
WPA3X1240
1
$7,101.00
Quantum 6000z
WPA3X1245
1
$7,101.00
Quantum 610
WPA3X1225
1
$7,101.00
Quantum 614
WPA3X1255
1
$7,101.00
Quantum R4000
WPA3X1250
1
$7,101.00
Quickie P-222
WPA3QU240
1
$7,101.00
Quickie Rhythm
WPA3QU260
1
$7,101.00
Quickie S-525
WPA3QU220
1
$7,101.00
Quickie S-646 (S-626)
WPA3QU230
1
$7,101.00
Quickie X2
WPA3QU290
1
$7,101.00
Quickie Xcel
WPA3QU300
1
$7,101.00
Quickie Xperience
WPA3QU280
1
$7,101.00
Quickie Xplore
WPA3QU270
1
$7,101.00
Invacare
Nutron Series R51lxp
WPK1IN015
1
$5,424.00
Pride
Mobility
Products
Jazzy Select 6
WPK1X1230
1
$5,424.00
Quickie
Quickie V-121
WPK1QU025
1
$5,424.00
Paediatric Power Base Type 2
Invacare
Tiger
WPK2IN015
1
$6,385.00
Wheelchair type suitable for use on most
surfaces. Primarily for user who requires
postural support, modifications to electronics,
and other specific options to support
independent mobility. ADP price includes seat
and back frame (sizes up to 16" wide x
16"deep), standard joystick control, swing away
detachable footrests, height adjustable
armrests, 2 point seat belt any closure, front
casters, wheels. See Power Wheelchair
Options Chart for other basic components
funded by ADP.
Quickie
Quickie V-521
WPK2QU405
1
$6,385.00
Adult Power Base Type 3
Wheelchair type suitable for use on most
surfaces. Primarily for the user who requires
ongoing changes in postural support,
modifications to electronics, and other specific
options to support independent mobility. ADP
price includes base, 2 point seat belt any
closure and standard joystick control. See
Power Wheelchair Options Chart for other basic
components funded by ADP.
Manufacturer
Pride
Mobility
Products
Quickie
Paediatric Power Base Type 1
Wheelchair type most suitable for use on hard,
flat surfaces. Primarily for user who requires
minimal adjustments to support independent
mobility. ADP price includes seat and back
frame (sizes up to 16" wide x 16"deep),
standard joystick control, swing away
detachable footrests, height adjustable
armrests, 2 point seat belt any closure, front
casters, wheels. See Power Wheelchair
Options Chart for other basic components
funded by ADP.
Device
Page: 67 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Power)
Device Type
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Paediatric Power Base Type 3
Handicare
Alex Power Wheelchair
WPK3M9005
1
$6,843.00
Wheelchair type suitable for use on most
surfaces. Primarily for the user who requires
ongoing changes in postural support,
modifications to electronics, and other specific
options to support independent mobility. ADP
price includes base, 2 point seat belt any
closure, and standard joystick control. See
Power Wheelchair Options Chart for other basic
components funded by ADP.
Invacare
Arrow Storm
WPK3IN010
1
$6,843.00
Fdx
WPK3IN080
1
$6,843.00
Storm Torque
WPK3IN015
1
$6,843.00
Tdx Sp/Sr
WPK3IN070
1
$6,843.00
Tdx Spree
WPK3IN075
1
$6,843.00
C300 Corpus Junior / K300
WPK31P010
1
$6,843.00
C400 Corpus Junior
WPK31P015
1
$6,843.00
Quantum 600
WPK3X1220
1
$6,843.00
Quantum 6000
WPK3X1240
1
$6,843.00
Quantum 6000z
WPK3X1245
1
$6,843.00
Quantum 610
WPK3X1225
1
$6,843.00
Quantum 614
WPK3X1255
1
$6,843.00
Quantum R4000
WPK3X1250
1
$6,843.00
Quickie P-222
WPK3QU020
1
$6,843.00
Quickie Rhythm
WPK3QU040
1
$6,843.00
Quickie S-525
WPK3QU010
1
$6,843.00
Quickie Xperience
WPK3QU080
1
$6,843.00
Quickie Xplore
WPK3QU070
1
$6,843.00
Tdx Spree
WPK4IN075
1
$6,505.00
Tiger
WPK4IN005
1
$6,505.00
Quickie
Quickie Z-500
WPK4QU005
1
$6,505.00
Activelite
Mobility
Easy Travel -3 Wh.
WS16A0005
1
$3,041.00
Advanced
Vehicle
Concepts
Quingo Classic
WS15V0005
1
$3,041.00
Fortress
1700fs -3 Wh.
WS1FS0015
1
$3,041.00
1700fs -4 Wh.
WS1FS0020
1
$3,041.00
2000fs -3 Wh.
WS1FS0005
1
$3,041.00
2000fs -4 Wh
WS1FS0010
1
$3,041.00
Winner -3 Wh.
WS1FS0070
1
$3,041.00
Winner -4 Wh.
WS1FS0075
1
$3,041.00
Auriga - 3 Wh.
WS1IN0070
1
$3,041.00
Permobil
Pride
Mobility
Products
Quickie
Paediatric Power Base with Manual
Dynamic Tilt
Wheelchair type offers manual dynamic tilt
required by the user who can not maintain a
functional posture through the use of seating
components alone. ADP price includes dynamic
tilt frame (sizes up to 16" wide x 16"deep),
standard joystick control, swing away
detachable footrests, height adjustable
armrests, 2 point seat belt any closure, front
casters, wheels. See Power Wheelchair
Options Chart for other basic components
funded by ADP.
Power Scooter
Device is suitable for the user who requires
power mobility to meet their long term basic and
essential mobility requirements, and does not
require specific postural support now or in the
future. ADP price includes base, tiller and seat.
ADP funding for positioning devices (seating) is
not available for scooters. See Power
Wheelchair Options Chart when heavy duty
models are required.
Invacare
Invacare
Page: 68 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Power)
Device Type
Power Scooter
Device is suitable for the user who requires
power mobility to meet their long term basic and
essential mobility requirements, and does not
require specific postural support now or in the
future. ADP price includes base, tiller and seat.
ADP funding for positioning devices (seating) is
not available for scooters. See Power
Wheelchair Options Chart when heavy duty
models are required.
Manufacturer
Invacare
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Auriga - 4 Wh.
WS1IN0075
1
$3,041.00
Leo Scooter 4 Wheel
WS1IN0085
1
$3,041.00
Meteor - 4 Wh.
WS1IN0080
1
$3,041.00
Maple Leaf
Power Plus
Mp3 -3 Wh.
WS1WN0005
1
$3,041.00
Mp4 -4 Wh.
WS1WN0010
1
$3,041.00
Nexidea
Health
Products
Hs320c.T.M.-3 Wh.
WS1UI2020
1
$3,041.00
Hs360c.T.M.-4 Wh.
WS1UI2000
1
$3,041.00
Hs570c.T.M.-3 Wh.
WS1UI2005
1
$3,041.00
Hs580c.T.M.-4 Wh.
WS1UI2010
1
$3,041.00
Hs666c.T.M.-3 Wh.
WS1UI2015
1
$3,041.00
Hs686c.T.M.-4 Wh.
WS1UI2025
1
$3,041.00
Celebrity X - 3 Wh.
WS1X10010
1
$3,041.00
Celebrity X - 4 Wh.
WS1X10015
1
$3,041.00
Celebrity Xl - 4 Wh.
WS1X10017
1
$3,041.00
Gogo Elite Traveller Plus - 3 Wh.
WS1X10100
1
$3,041.00
Gogo Elite Traveller Plus - 4 Wh.
WS1X10105
1
$3,041.00
Hurricane
WS1X10085
1
$3,041.00
Legend Xl
WS1X10045
1
$3,041.00
Maxima -3 Wh.
WS1X10060
1
$3,041.00
Maxima -4 Wh.
WS1X10065
1
$3,041.00
New Legend -3 Wh.
WS1X10030
1
$3,041.00
New Legend -4 Wh.
WS1X10040
1
$3,041.00
Revo Sc63 - 3 Wh.
WS1X10090
1
$3,041.00
Revo Sc64 - 4wh.
WS1X10095
1
$3,041.00
Victory 10 - 3 Wh, 3 Wh Twin
WS1X10110
1
$3,041.00
Victory 10 - 4 Wh
WS1X10115
1
$3,041.00
Chameleon Gkb - 3 Wh
WS1S7005
1
$3,041.00
Chameleon Gkb - 4 Wh
WS1S7010
1
$3,041.00
Cobra 778el -3 Wh.
WS1S70020
1
$3,041.00
Cobra 778el -4 Wh.
WS1S70025
1
$3,041.00
Landcruiser 889-3wh.
WS1S70035
1
$3,041.00
Landcruiser 889xls 4wh.
WS1S70036
1
$3,041.00
Sovereign 888 -3 Wh.
WS1S70030
1
$3,041.00
Sovereign 888 -4 Wh.
WS1S70032
1
$3,041.00
Trailblazer 889sel 4wh.
WS1S70045
1
$3,041.00
Voyager 778s -3 Wh.
WS1S70037
1
$3,041.00
Voyager 888sel -4 Wh.
WS1S70040
1
$3,041.00
Pride
Mobility
Products
Shoprider/
Pihsiang
Page: 69 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Power)
Device Type
Manufacturer
Yelle &
Associates
Device is suitable for the user who requires
power mobility to meet their long term basic and Ltd.
Power Scooter
essential mobility requirements, and does not
require specific postural support now or in the
future. ADP price includes base, tiller and seat.
ADP funding for positioning devices (seating) is
not available for scooters. See Power
Wheelchair Options Chart when heavy duty
models are required.
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Freedom - 3 Wh.
WS1YE0030
1
$3,041.00
Safari/Ltd-3 Wh.
WS1YE0020
1
$3,041.00
Solo Ltd-4 Wh.
WS1YE0007
1
$3,041.00
Solo/Ltd-3 Wh.
WS1YE0005
1
$3,041.00
Solo/Xt550-4 Wh.
WS1YE0010
1
$3,041.00
Page: 70 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Power)
OPTIONS:
Device Type
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Adjustable Tension Back Upholstery
over 18" Frame Width
WEPE
1
$240.00
Adjustable Tension Back Upholstery
up to 18" Frame Width
WEPD
1
$140.00
Angle Adjustable Footplates (pair)
WEPJ
1
$117.00
Auto Correction System*
WEPQ
1
$1,500.00
WEPF
1
$556.00
WEPG
1
$667.00
WEPH
1
$979.00
Manual Elevating Legrests (pair)
WEPK
1
$391.00
Manual Recline Option
WEPI
1
$749.00
Midline Control
WE3D
1
$340.00
SPECIALIZED ELECTRONICS FOR POWER
WHEELCHAIRS (WPA3, WPK3) Offers
increased driving control through specific autocorrection system; for client with limited trunk
and/or upper extremity control. Authorizer must
provide clinical rationale to support the request.
Selected device must meet clinical
requirements.
Heavy Duty Model, Client Weight
Exceeds 250 Lbs
HEAVY DUTY MODEL REQUIRED, CLIENT
WEIGHT EXCEEDS 250LBS. Authorizer must
document client weight. Selected device must
meet weight requirements.
Heavy Duty Model, Client Weight
Exceeds 350 Lbs
HEAVY DUTY MODEL REQUIRED, CLIENT
WEIGHT EXCEEDS 350LBS. Authorizer must
document client weight. Selected device must
meet weight requirements.
Heavy Duty Model, Client Weight
Exceeds 400 Lbs
HEAVY DUTY MODEL REQUIRED, CLIENT
WEIGHT EXCEEDS 400LBS. Authorizer must
document client weight. Selected device must
meet weight requirements.
Multi-function Control Box
Amysystems
Multi-Function Control Box MultiFunction Control Box, For Use On
Systems With Multiple Functions
Including Tilt And Power
Legs, Tilt, Recline And Power Legs Etc.
SEC4P5005
1
$2,048.00
Invacare
Multi-Function Control Box MultiFunction Control Box For Use On
Systems With Multiple Functions.
Including Tilt
And Power Legs, Tilt, Recline And
Power Legs Etc.
SECIN5005
1
$1,841.00
Page: 71 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Power)
OPTIONS:
Device Type
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Motion
Concepts
Trx Helix Multi-Function Control Box
(Thmc) Trx Helix Multi-Function Control
Box (Thmc)
For Use On Systems With Multiple
Functions,
Including Tilt And Power Legs, Tilt,
Recline, Power Legs,
Etc. Includes Reduced Drive With
Elevate.
SECZG5005
1
$1,820.00
Permobil
Multi-Function Control Box MultiFunction Control Box - For Use On
Systems
With Multiple Functions Including, Tilt
And
Power Legs, Tilt, Recline And Power
Legs, Etc.
SEC1P1005
1
$2,142.00
Pride
Mobility
Products
Multi-Function Control Box MultiFunction Control Box - Advanced
Acutator Module (Aam)
SECX15005
1
$596.00
Quickie
Multi-Function Control Box MultiFunction Control Box For Use On
Systems With Multiple
Functions, Including Tilt And Power
Legrest, Tilt, Recline,
Power Legrests Etc.
SECQU4005
1
$2,786.00
One Piece 90/90 Front Riggings
WEPL
1
$213.00
Oxygen Tank Holder
WEPX
1
$135.00
PW - Custom Modifications
PWCM
1
Multi-function Control Box
Power Elevating Footrests
Power Recline Only
Amysystems
Power Elevating & Articulating Legrests
SEF4P0005
1
$2,609.00
Motion
Concepts
Power Elevating At5544 Legrest
Package For Invacare
And Quickie Bases. Includes Legrests
And Actuators.
SEFZG0010
1
$2,567.00
Power Elevating Legrests For Invacare,
Quantum, And
Quickie Bases. Includes Legrests And
Actuators.
SEFZG0005
1
$2,567.00
Permobil
Power Elevating Articulating Leg Rests
SEF1P0005
1
$2,637.00
Pride
Mobility
Products
Articulating Foot Platform
SEFX13010
1
$2,795.00
Power Elevating Articulating Leg Rests
SEFX13005
1
$2,543.00
Quickie
Power Elevating/Articulating Leg Rests
SEFQU0005
1
$2,609.00
Tarsys
(Invacare)
Power Elevating Legrests
SEFTY0005
1
$2,746.00
Amysystems
Power Recline With Integrated Shear
Reduction (Isr)
SEC4P0010
1
$4,289.00
Power Recline With Integrated Shear
Reduction (Isr)
SEC4P0045
1
$7,462.00
Page: 72 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Power)
OPTIONS:
Device Type
Power Recline Only
Manufacturer
Invacare
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
12" 20" Recline Only
SECIN1010
1
$9,286.00
21" - 24" Recline Only
SECIN1015
1
$10,041.00
Power Recline Only With Power Sliding
Back (Psb) For
Invacare, Quantum, And Quickie Bases.
SECZG0015
1
$8,698.00
Power Recline System With Esr For
Invacare,
Quickie, And Quantum Bases
SECZG1010
1
$9,534.00
Power Recline System With Extended
Shear Reduction (Esr) For
Invacare, Quantum, And Quickie Bases.
SECZG0010
1
$8,138.00
Permobil
Corpus Power Positioning System With
Power Recline Only
SEC1P0010
1
$6,958.00
Pride
Mobility
Products
Tru-Balance 2 Power Recline
SECX12055
1
$6,300.00
Amysystems
Amy Seat Cg Power Tilt
SEC4P0005
1
$5,129.00
Amy Seat Ii Cg Power Tilt
SEC4P0040
1
$6,062.00
21" - 24" Tilt Only
SECIN1005
1
$7,003.00
Formula Cg Tilt And Recline 12" - 20"
Tilt Only
SECIN1000
1
$6,249.00
Trx Low-Pro Bariatric Cg Systems
Power Tilt Only For Invacare, Quantum,
And Quickie Bases.
SECZG1005
1
$7,462.00
Trx-Cg Systems, Cg, Low Pro, Ultra Low SECZG0005
Power Tilt Only For Invacare, Quantum,
And Quickie Bases.
1
$6,067.00
Corpus Hd Power Positioning System
Corpus Hd Power Positioning System
With 30 Deg.
Power Tilt Only
SEC1P0105
1
$10,635.00
Corpus Power Positioning System
Corpus Power Positioning System With
45 Deg. Power Tilt Only
SEC1P0005
1
$6,155.00
Ps Power Positioning System Ps Power
Positioning System With 45 Deg. Power
Tilt Only
SEC1P0205
1
$5,222.00
Pride
Mobility
Products
Tru-Balance 2 Tru-Balance 2 Power Tilt
SECX12050
1
$5,595.00
Tue-Balance Tru-Balance Power Tilt
SECX12005
1
$5,320.00
Quickie
Power C.G. Tilt For Quickie G-424 &
S-525
SECQU1005
1
$5,431.00
Power C.G. Tilt For Quickie P-222se
SECQU1015
1
$5,479.00
Power C.G. Tilt For Quickie Rhythm
SECQU3005
1
$5,502.00
Power C.G. Tilt For Quickie S-626
SECQU1010
1
$5,431.00
Motion
Concepts
Power Tilt Only
Device
Invacare
Motion
Concepts
Permobil
Page: 73 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Power)
OPTIONS:
Device Type
Manufacturer
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Cg Power Tilt & Power Recline With
Integrated
Shear Reduction (Isr)
SEC4P0015
1
$7,275.00
Cg Power Tilt & Power Recline With
Integrated Shear
Reduction (Isr)
SEC4P0050
1
$10,728.00
16" 20" Tilt And Recline
SECIN1020
1
$10,382.00
21" - 24" Tilt And Recline
SECIN1025
1
$11,136.00
Power Tilt And Power Recline For
Invacare,
Quickie, And Quantum Bases.
SECZG0018
1
$9,683.00
Power Tilt And Power Recline For
Invacare, Quantum, And
Quickie Bases.
SECZG2010
1
$8,866.00
Power Tilt And Power Recline With Esr
For
Invacare, Quantum, And Quickie Bases
SECZG0020
1
$10,210.00
Power Tilt And Power Recline With Esr
For Invacare,
Quantum, And Quickie Bases.
SECZG2015
1
$9,394.00
Power Tilt And Power Recline With Esr
For Invacare,
Quickie, And Quantum Bases.
SECZG1015
1
$10,775.00
Power Tilt And Power Recline With Psb
For
Invacare, Quantum, And Quickie Bases.
SECZG0025
1
$10,770.00
Power Tilt And Power Recline With Psb
For Invacare,
Quantum, And Quickie Bases.
SECZG2020
1
$9,954.00
Permobil
Corpus Power Positioning System With
45 Deg. Power Tilt
And Power Recline
SEC1P0015
1
$10,262.00
Pride
Mobility
Products
Tru-Balance 2 Power Tilt And Recline
SECX12060
1
$10,500.00
Quickie
Smart Seat Tilt & Recline System
SECQU2005
1
$10,733.00
Seat Depth Required is Greater Than
18"
WEPB
1
$292.00
Seat Package 1 for Power Bases
WEPN
1
$842.00
WEPO
1
$866.00
Power Tilt and Recline
Amysystems
Device
Invacare
Motion
Concepts
SEAT PACKAGE 1 FOR POWER BASES
(includes frame, sling upholstery, armrests,
footrests.)
Seat Package 2 for Power Bases
SEAT PACKAGE 2 FOR POWER BASES
(includes deluxe seat and back, armrests,
footrests.) No positioning devices (seating)
allowed with this code.
Page: 74 of 75
Assistive Devices Program
Product Catalogue
Ministry of Health and Long-Term Care
Mobility Devices
Effective From: 2011-Jun-13
Wheelchairs (Power)
OPTIONS:
Device Type
Manufacturer
Device
ADP Code
Max
Allowed
Qty.
ADP
Approved
Amt.
Seat Width Required is Greater Than
18"
WEPA
1
$430.00
Specialty Controls 1 Non Standard
Joystick*
WEX1
1
$1,400.00
WEX2
1
$3,000.00
WEX3
1
$6,700.00
WEX4
1
$7,500.00
WEX5
1
$3,000.00
WEX6
1
$5,000.00
Swingaway Mounting Bracket
WEPM
1
$294.00
Ventilator Tray
WEPY
1
$1,690.00
SPECIALTY CONTROLS 1- SIMPLE NON
STANDARD JOYSTICK (includes mounting
hardware, upgraded electronics & labour).
Authorizer must provide clinical rationale to
support the request. Selected device must meet
clinical requirements.
Specialty Controls 2 Chin/Rim
Control*
SPECIALTY CONTROLS 2 - COMPLEX NON
STANDARD JOYSTICK - (includes upgraded
electronics, mounting hardware, display,
joystick modifications & labour). For chin/rim
control etc. Authorizer must provide clinical
rationale to support the request. Selected
device must meet clinical requirements.
Specialty Controls 3 Simple Touch*
SPECIALTY CONTROLS 3 - SIMPLE TOUCH (includes mounting hardware, upgraded
electronics, display, cables, 4 switches &
labour). For footplate/headrest/tray switches
etc. Authorizer must provide clinical rationale to
support the request. Selected device must meet
clinical requirements.
Specialty Controls 4 Proximity
Control*
SPECIALTY CONTROLS 4 - PROXIMITY
CONTROL - (includes mounting hardware,
upgraded electronics, display, cables, 4
switches & labour). Authorizer must provide
clinical rationale to support the request.
Selected device must meet clinical
requirements.
Specialty Controls 5 Breath Control*
SPECIALTY CONTROLS 5 - BREATH
CONTROL - SIP'N'PUFF (includes mounting
hardware, upgraded electronics, display, cables
& labour). Authorizer must provide clinical
rationale to support the request. Selected
device must meet clinical requirements.
Specialty Controls 6 Scanners*
SPECIALTY CONTROLS 6 - SCANNERS
(includes mounting hardware, upgraded
electronics, display, cables, scanner & labour).
Authorizer must provide clinical rationale to
support the request. Selected device must meet
clinical requirements.
Page: 75 of 75
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