Page 1 of 13 INFINFB3572/RevD/01OCT2018 Q6 Edge ® HD Order Form with TRU-Balance ® 3 Positioning AADL #W592/W991 Weight:________ Height:________ PATIENT INFORMATION ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ A. Shoulder Width:_______ B. Chest Width: _________ C. Hip Width: ___________ D. Max Sitting Height: ____ E. Shoulder Height: ______ F. Axilla Height: _________ G. Thigh Depth: _________ H. Lower Leg Length: ____ I. Elbow Height: ________ INTRODUCTION This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applica- tions other than Acrobat. Complete the form by placing checks in the desired boxes and provide information in the interactive fields. Buttons shown at the bottom of the form may be utilized to print or submit the order form through a desktop email application. To email via a web-based application, please ‘Save As’ and attach the PDF to your email. This order form contains a large variety of options to fulfill various patient needs. Descriptions and section notes, such as optional or required, are included to help you complete your order. Please contact Quantum Sales at 888-570-1113 if assistance is needed. Send the completed order form by fax (866-514-1303) or email ([email protected]). Incomplete forms may delay the quote or order. Customer service will contact you if the order is incomplete or if there are compatibility issues. If special order requests are needed, be sure that the Patient Information section is completed or include a completed physical assessment form with this order form. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete power chair. Please contact technical service for accurate parts ordering. Options noted with "XRef" have multiple possible part numbers based on system configuration. Please see cross-reference spreadsheet for the XRef part numbers. Thank you for choosing Quantum! Account Number: ___________ Date: ________________ Provider Name: __________________________________ Contact: ________________________________________ Phone: ___________________ Fax: _________________ Email:__________________________________________ PO Number:_____________________________________ Marked for: _____________________________________ Ship to Address: _________________________________ City:_________________ Prov:______Postal:_________ Pride Mobility Products Co. For AADL use only 5096 South Service Rd, Beamsville, ON, L0R 1B3 Phone: 888-570-1113 | Fax: 866-514-1303 | Email: [email protected]
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Page 1 of 13INFINFB3572/RevD/01OCT2018
Q6 Edge® HD Order Form with TRU-Balance® 3 Positioning AADL #W592/W991
A. Shoulder Width: _______B. Chest Width: _________C. Hip Width: ___________
D. Max Sitting Height: ____E. Shoulder Height: ______F. Axilla Height: _________
G. Thigh Depth: _________H. Lower Leg Length: ____I. Elbow Height: ________
INTRODUCTION This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applica-tions other than Acrobat. Complete the form by placing checks in the desired boxes and provide information in the interactive fields. Buttons shown at the bottom of the form may be utilized to print or submit the order form through a desktop email application. To email via a web-based application, please ‘Save As’ and attach the PDF to your email. This order form contains a large variety of options to fulfill various patient needs. Descriptions and section notes, such as optional or required, are included to help you complete your order. Please contact Quantum Sales at 888-570-1113 if assistance is needed. Send the completed order form by fax (866-514-1303) or email ([email protected]). Incomplete forms may delay the quote or order. Customer service will contact you if the order is incomplete or if there are compatibility issues. If special order requests are needed, be sure that the Patient Information section is completed or include a completed physical assessment form with this order form. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete power chair. Please contact technical service for accurate parts ordering. Options noted with "XRef" have multiple possible part numbers based on system configuration. Please see cross-reference spreadsheet for the XRef part numbers.
Pride Mobility Products Co. For AADL use only5096 South Service Rd, Beamsville, ON, L0R 1B3Phone: 888-570-1113 | Fax: 866-514-1303 | Email: [email protected]
Quantum Q6 Edge HD .........................................$8,815Part: Q6 EDGEHD
BASE MOUNTED FOOT PLATFORMREQUIRED. Select a foot platform option. May interfere with seat mounted legrests. Not available with center mount foot platforms.
Base Mounted Foot Platform .............................StandardPart: FRMASMB16077 9.45"W x 10"D platform.
Base Mounted, Bell Shaped Foot Platform .......... No ChargePart: RIGASMB712004110.12"W tapering out to 14"W x 13.06"D platform.
Omit base mounted foot platform .................... No ChargePart: PTOINDV3674
DRIVE WHEELSREQUIRED. Select a type of drive wheels. Knobby tires increase overall base width by 1.5”. Standard battery and accessory pricing applies.
3" x 14” Run Flat Tires ....................................StandardPart: PTOINDV3510
3" x 14” Flat Free Tires ................................. No ChargePart: WHL124116
3" x 14” Pneumatic Tires ............................... No ChargePart: WHL124117
BASE COLORREQUIRED. Select one shroud color. Colors shown here may differ from actual product depending on monitor/printer calibration used.
BASE MODELREQUIRED. Select a power base. 450 lb. weight capacity with standard 4.7 mph programmable motors, 8 amp off board charger, and unoccupied transit loops. Dimensions of base without legrests: 26”Wx36.75”L.
Back in BlackPart: DGN150343-PBK1
Midnight BluePart: DGN150343-PBU10
Match to Base Color ......................................$42.50 ea.Part: Configuration selection, see specific part below
Non-matching Color ......................................$42.50 ea.Part: Configuration selection, see specific part below
Back in BlackPart: DGN164245-PBK1
Midnight BluePart: DGN164245-PBU10
Drive Wheel Accent Color Optional. Sold in Pairs (parts below will be a quantity of 2). Not available with knobby tires. Not covered by AADL
Non-Expandable ControlsSelect a joystick below or omit selection if another controller type is desired. Non-expandable does not allow supplementary drive controllers.
NE+ 6-Key Joystick (1 Actuator) ........ No ChargePart: CTLDC1560 Control of one actuator through Joystick on single pow-er base model only.
No Joystick, Setup for NE+ Joystick ... No ChargePart: Configuration selection NE+ 6-Key Joystick (2 Actuators) No ChargePart: CTLDC1560 Control up to 2 actuators through joystick.
NE+ 8-Key Joystick (2 Actuators) ...... No ChargePart: CTLDC1561Control up to 2 actuators and LED, Full Light Package through joystick.
ELECTRONICSREQUIRED. Select a type of drive control from the following sections. The No Joystick option is used to omit the joystick and utilize another control, such as a specialty control at the end of this form or found on the Alternative Controls and Electronics Order Forms.
Q-Logic 3 EX Joystick ...........................................$900Part: CTL167724
Q-Logic 3 EX Joystick for LED, Full Light Package ........$900Part: CTL167725
No Joystick, Setup for Q-Logic 3Part: Configuration selection.
Q-Logic 3 Joystick
Expandable Controls - Quantum Intelligent Systems™Select expandable controls or omit selection if another controller type is desired. Expandable controls allow multiple or specialized controllers. This sections allows a selection of common configurations.
Q-Logic 3 Joystick ShroudREQUIRED with Q-Logic 3 EX Joystick selection above. Colors are shown on page 2. Price will be assigned to color part number.
Non-matching Shroud ............. $75Part: PTOINDV3422Select color below. Not covered by AADL
Match Shroud ....................... $75Part: PTOINDV3421 Not covered by AADL
Back in BlackPart: DGN124336-PBK1
Midnight BluePart: DGN124336-PBU10
Switch Operated Fender Lights..................................................................................... $240*Part: DGN154117*Will be included at no charge with iLevel 10" Lift system. Fender lights operate by pressing included single switch
FENDER LIGHTINGOptional. Fender lighting is not available with NE 4-Key joystick or Single Actuator Control through Toggle Box. Stan-dard battery and accessory pricing applies. Not covered by AADL
Fender Lights
FULL LIGHT PACKAGESOptional. Requires NE+ 8 Key or Q-Logic 3 Joystick for Full Light Package. Standard battery and accessory pricing applies. Not covered by AADL
Seat Mounted, LED, Full Light Package .............................................................................$770Part: ELE131477
Seat Mounted LEDLights (One Shown)
Q-Logic 3 EX Joystick
SCIM ModuleOptional
SCIM Module Kit for Q-Logic 3 ........................................................................................$850Part: CTL168055Allows use of joystick display for specialty devices. Available with Q-Logic 3 EX Joystick selection above. Up to 5 profiles to control drive, seat, and auxiliary functions, excluding sip-n-puff and single switch functions. A switch is required to operate the input device attached to the SCIM module. SCIM Module
JOYSTICK HANDLESOptional. The NE/NE Plus joysticks are standard with a carrot handle (See A in image). The standard Q-Logic 3 joystick knob can be seen in the image on the previous page. The optional handle will be mounted to the joystick and the standard handle will be shipped with the unit. Standard battery and accessory pricing applies.
3” Goal Post Handle ...............................$180Part: PLSKNCP1057
4” Goal Post Handle ...............................$180Part: PLSKNCP1058
Q-Logic 3 Carrot Handle (A) ............. No ChargePart: DGN124308
Swing-away, Inline, Left Side Mount .......... $265NE/NE+ Part: ACC142526 ADP: WEPMQ-Logic: ACC142524
Swing-away, Inline, Right Side Mount ........ $265NE/NE+ Part: ACC142527 ADP:WEPMQ-Logic: ACC142525
Swing-away, Inline, Left Side Mount .......... $265NE/NE+ Part: ACC142526 Q-Logic: ACC142524
Swing-away, Inline, Right Side Mount ........ $265NE/NE+ Part: ACC142527 Q-Logic: ACC142525
Swing-away, 1” Offset, Left Side Mount ..... $265NE/NE+ Part: ACC142747 Q-Logic: ACC142742
Swing-away, 1” Offset, Right Side Mount .... $265NE/NE+ Part: ACC142748 Q-Logic: ACC142743
Swing-Away (Retractable) Bracket Allows the joystick to retract to the side of the armrest while maintaining the same joystick orientation. "Inline brack-et" is used with TRU-Balance 3 arms when the joystick is inline with armpad. "Inline bracket" will be offset 1" when used with tube style arms. Select "Offset Bracket" to have the joystick inline with armpad on tube style armrests.
Multi-axis, Left Side Mount ......................$100NE/NE+ Part: ACC142528 Q-Logic: ACC131216
Multi-axis, Right Side Mount ....................$100NE/NE+ Part: ACC142528 Q-Logic: ACC131216
Stealth Swing-Away/Flip Down Bracket ...... $300Left Side Mount
Stand Alone Part: ST-TWBM480CJ-Q Q-Logic Part: ST-TWBM480QL-Q
Stealth Swing-Away/Flip Down Bracket ...... $300Right Side Mount
Stand Alone Part: ST-TWBM480CJ-Q Q-Logic Part: ST-TWBM480QL-Q
Retract4, Left Side Mount ...................... $450NE/NE+ Part: MEC138876 Q-Logic: MEC138860
Retract4, Right Side Mount ..................... $450NE/NE+ Part: MEC138876 Q-Logic: MEC138860
Retract4 Swing-Away Arm KitFull 180° of movement that translates into multi-position use, straight, right offset, left offset, or fold away. Joystick orientation varies as bracket is adjusted.
Multi-AxisAllows height adjustment of joystick.
Stealth Swing Away/Flip Down BracketAllows the joystick to pivot to side of armrest, or flip-down if bracket is adjusted.
TRU-BALANCE® 3 SEATING - Quantum Intelligent Systems™REQUIRED. Select one seating system. Be sure to complete the Seat Dimension, Seat to Floor, and back selections.
TRU-Balance® 3 Configuration
TRU-Balance 3, Heavy Duty, 10” Power Lift with iLevel® and Fender Lights ............................ $2,895Part: PTOINDV3797. 400 lb weight capacity. 24”W x 24”D maximum seat size. Includes fender lights found on page 2. Not covered by AADL
10” Power Lift - iLevel SystemOptional. Select one option below.
Seat DimensionsREQUIRED with seat selection. Select width and depth package and enter desired set width and depth in that available package range, available in 1” increments. Configurations disallowed or not shown may be available through special order. Maximum non-lift seat size is 32"W x 25"D. Maximum lift seat size is 24"Wx25"D. Seat depth of 25" D is attainted by using the 20"-24" Depth Package. Parts: See XRef: TB3SPACK
16”-20” Depth PackageMinimum Seat Depth is 20"
20”-24” Depth PackageUse with 25" Depth
Not available with power lift:
20” D(#1010)
21” D(#1011)
22” D(#1012)
23” D(#1013)
24” D(#1014)
25” D(#1060)
20” W(#1010)
21” W(#1011)
22” W(#1012)
23” W(#1013)
24” W(#1014)
25” W(#1056)
26” W(#1054)
27” W(#1057)
28” W(#1055)
29” W(#1058)
30” W(#1059)
31” W(#1060)
32” W(#1061)
Set Width at:______ Part: SETWDTH#, see below
Set Depth at:______ Part: SETDPTH#, see below
Static Seat Only or Recline Only
Tilt Only, Tilt and Recline, or Any Power Lift Configuration
Seat to Floor HeightREQUIRED. Select a seat to floor height compatible with the seat functions previously selected.
16.5” Seat to FloorPart: PTOINDV3459
17.5” Seat to FloorPart: PTOINDV3460
18.5” Seat to FloorPart: PTOINDV3463
18.5” Seat to FloorPart: PTOINDV3463
19.5” Seat to FloorPart: PTOINDV3505
20.5” Seat to FloorPart: PTOINDV3528
ELECTRONICS ACCESSORIESOptional. Standard battery and accessory pricing applies. Standard battery and accessory pricing applies.
USB Mobile Device Charger ......................$185Can charge 1 device. An additional multiplier harness may be needed. Reference multipler chart at end of or-der form. Not covered by AADL USB Media
Device Charger
TRU-Balance 3 Static Seat ...................................$1,045Part: PTOINDV3442 Standard with Angle Adjustable Back Canes.
TRU-Balance 3 Power Tilt ....................................$7,555Part: PTOINDV3443. 50° Center of Gravity (CG) power tilt seating system.
TRU-Balance 3 Power Recline ..............................$7,875Part: PTOINDV3444. 175° of power recline.
TRU-Balance 3 Power Tilt & Recline ......................$13,125Part: PTOINDV3446. 50° CG power tilt with 175° of power recline. Full drive lockout at 20°.
1” Endo ..................................................... No ChargePart: MEC141455
2” Endo ..................................................... No ChargePart: MEC141456
Back Cane TypeSelect with Back Cane Option selected above.
Back SelectionREQUIRED. Match choice in this section with the options in the back cushion configuration section.
TRU-Balance 3 Back Assembly (Static Back)Part: Configuration selectionSelect a back cushion configuration in the subsequent section.
Back Cane OptionPart: Configuration selectionAvailable only with TRU-Balance 3 Static Seat and Power Tilt (1 actu-ator) selections. Select back cane type, back cane height, and back cushion configuration.
Back Cane HeightSelect with Back Cane Option selected above.
16”High CanePart: FRMASMB15834
17”High CanePart: FRMASMB15835
20”High CanePart: FRMASMB15838
21”High CanePart: FRMASMB15839
24”High CanePart: FRMASMB15842
25”High CanePart: FRMASMB15843
Sport Back.................................................. No ChargePart: See XRefComplete following width package and size.
Omit Back Pan/Cushion .................................. No ChargePart: PTOINDV1287Select a following width package.
After-market Back Interface ........................... No ChargePart 16"-20"W: SET131920. Part 20"-24"W: SET131921Enter the set width below, range of 16"-24". Overall seat depth may
need to be adjusted to accommodate certain backs. May interfere with gel/waterfall armpads and arm through. Does not include brack-ets to mount after-market backs. A Special Order is required on back widths less than 16”.
Back Cushion ConfigurationREQUIRED. Select a configuration type and applicable dimensions. See the Sport, Q-Back, and TRU-Comfort 2 back availability chart for stock order back size ranges. Other size backs may be available with Special Order and extended lead time.
Match Seat Width SelectionsPart: PTOINDV3468
16”W-20”W PackagePart: Configuration selection, back cushions
20”W-24”W PackagePart: Configuration selection, back cushions
24”W-28”W PackagePart: Configuration selection, back cushions
28”W-32”W PackagePart: Configuration selection, back cushions
Back Cushion WidthAvailable with +/-4” of seat width. Reference chart for available back width.
Tilt or Static Back Width Recline Back Width
Sport and TRU-Comfort 2 Back Availability Chart
Ove
rall
Back
Hei
ght
Sport or TRU-Comfort 2 BackSport Back
Set Back Width at:______ Part: PTOINDV#, see below
18” W(#3566)
19” W(#3567)
20” W(#3568)
21” W(#3569)
22” W(#3570)
24” W(#3571)
26” W(#3572)
28” W(#3573)
30” W(#3574)
32” W(#3575)
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There is no discount on the Edge HD power positioning for ordering only back canes.
Back Cushion Overall HeightStatic Seat and Power Tilt available height range: 16”-25”H. Odd heights include 4” gap and even heights include 3” gap between seat pan and bottom of back cushion. Power Recline available height range: 19”-28”H. Odd heights include 6” gap and even heights include 7” gap. See the Sport and TRU-Comfort 2 back availability chart for stock order back size ranges.
Set Overall Height at:______ Part: SETHGTH#, see below
16” High(#1029)
17” High(#1030)
18” High(#1031)
19” High(#1032)
20” High(#1033)
21” High(#1034)
22” High(#1035)
23” High(#1036)
24” High(#1037)
25” High(#1038)
26” High(#1039)
27” High(#1040)
28” High(#1041)
TRU-Balance 3 Back ShroudREQUIRED. The back shroud is a feature of the TRU-Balance 3 seating system and is available in matching shroud colors. The back shroud is not available with the back cane configuration. Reference colors shown on page 2.
Back in BlackPart: DGN148032
Midnight Blue $105
Part: DGN148035
Additional TRU-Balance 3 Back OptionsOptional.
TRU-Comfort Lateral Positioning Wedge, pair ..... No ChargePart: SET123465 Available with TRU-Comfort backs. Not available on power tilt backs 16”-17”H with limited adjustability on 18” H. Not available on power recline back 19”-20”H with limited adjustability on 21”H.
Privacy Flap, 9.75” ............................................... $40Part: DWR1044E456BStandard on recline seating systems. Not covered by AADL
Privacy Flap, 12.75” ............................................. $40Part: DWR1044E456AStandard on recline seating systems. Not covered by AADL
Heavy Duty, Removable ArmrestsSelect a type of HD removable armrests and the set height in the following section. Only one height package is selectable as a normal config-uration.
8”-12”H, Single Post, Height Adjustable, ............. $130 ea.Removable, Heavy Duty (Sold as pair) Part: See XRef.
10”-14”H, Single Post, Height Adjustable, ............ $130 ea.Removable, Heavy Duty (Sold as pair) Part: See XRef.
TRU-Balance 3 Flip-Back, 8”-12”H ..................StandardPart: See XRef
TRU-Balance 3 Flip-Back, 12”-16”H ................StandardPart: See XRef
ARMRESTSREQUIRED. Select the desired type of armrest below. Please read notes to ensure seating compatibility. Be sure to also select an armrest size and armpad type.
TRU-Balance 3 Flip-Back ArmrestsChoose a left and right TRU-Balance 3 armrest and set height in the following section. An optional downpost is also available. Different Left (L) and Right (R) armrest height packages are allowed. Not available with Back Cane Option.
TRU-Balance 3 Armrest Downpost (Pair) .................................................................................................. No ChargePart: See XRefAvailable up to 2” difference between seat and back width via endomorph or mesomorph configuration. Not available on 14” Width seat or back.
ARMREST SIZEREQUIRED. Select a Left (L) and Right (R) armrest size. This also affects the foam and waterfall armpad selection below.
No Armpad Selection and/or See Positioning Components Page or Order Form ................................................. No ChargePart: Configuration selection
ARMPADSREQUIRED. Select to omit an armpad selection or select a left and right armpad type. Please note that waterfall and gel armpads may cause interference with the seat back.
Height AdjustableReceiver (Track Arm)
Height AdjustableReceiver (Tube Arm)
JOYSTICK BRACKET RECEIVERREQUIRED.
Standard Fixed Receiver ..................................StandardPart: ACC123525
Stealth Height Adjustable Receiver .......................... $165Tube Arm Part: ST-ARM250C-Q. Track Arm Part: ST-ARM250T-Q.
ARMREST HEIGHTREQUIRED. Set left and right armrest height. Note the available height range in the option description.
Set Left Height at:______ Set Right Height at:______ 8” HighPTOINDV3535
9” HighPTOINDV3536
10” HighPTOINDV3537
11” HighPTOINDV3538
12” HighPTOINDV3539
13” HighPTOINDV3540
14” HighPTOINDV3541
15” HighPTOINDV3542
16” HighPTOINDV3543
8” HighPTOINDV3450
9” HighPTOINDV3451
10” HighPTOINDV3452
11” HighPTOINDV3453
12” HighPTOINDV3454
13” HighPTOINDV3455
14” HighPTOINDV3456
15” HighPTOINDV3457
16” HighPTOINDV3458
Straight, Armpad .......................................Standard Waterfall, Armpad .................................... No Charge
Falcon Gel ArmpadsSold only in pairs. Select an armpad set below. Armpads are 3” wide. The mounting plate allows the armpad to be offset from the armrest tube.
Foam ArmpadsSelect a left and right standard type armpad (mix or match) OR choose the gel armpads that follow.
Falcon Gel Left and Right Armpad:Full Length .................................................... $150 eaDesk Length .................................................. $100 eaFor use with TB3 standard armrests.
Falcon Gel Left and Right Armpad with Mounting Plate:Full Length. ................................................... $150 eaDesk Length .................................................. $100 eaFor use with 2-Post, Heavy Duty Removable, or Pediatric Armrests.
Push Handles (pair) ...............................$140Not available with oxygen holder, back cane option, or vent tray. Required with attendant manual recline.
Accessory Bar ....................................... $90Standard with the Trilogy vent tray, and oxygen holder. May be added to mount additional accessory to back of unit. Not available with back cane option.
Trilogy Vent Tray
Compact Vent Tray
POWER LEGREST CONTROLOptional. Specific power legrest options are selected later in this form. Select the control type here, if power legrests are desired, to assist the selection of the power positioning electronics.
POWER POSITIONING ELECTRONICSREQUIRED, except with Static Seat without power options. Select the desired control type for the seating system. Please note the available actuator controls. The 4-way toggle and 4 function push button are mounted on the same side as the joystick.
ATTENDANT CONTROLOptional. *Attendant control will be at no charge when ordered with Tilt and Recline, alternative drive controls, and a Q-Logic Display or SCIM module. Mounting bracket is included.
Attendant Control ..............................................$950*Part: ELE167862.
Through NE+ ................................ No Charge
Through Q-Logic Joystick ................ No Charge
Switch Controls
iAccessFlat Button
iAccessToggle Button
Single Power Electronics (includes AM1)
Through Toggle Control (Tilt Only) ................... No Charge
Through Q-Logic 3 Controller and ............ $625Interface
Through Flat Button iAccess and ............ $1,525Q-Logic 3 Controller and Interface
Programmable up to 15 functions. Only available with TRU-Balance 3 armrests.
Through Toggle Button iAccess and ........ $1,525Q-Logic 3 Controller and Interface
Programmable up to 15 functions. Only available with TRU-Balance 3 armrests.
Single/Multiple Power Electronics (includes AAM)
LEGRESTSOptional. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guide-lines. Some adjustments may be needed upon receipt of the unit. Reference the section’s compatibility matrix for legrest interference.
Center Mount Foot PlatformsIf power articulating foot platform is selected, be sure power legrest control has been selected in previous section. Select legrest length in following section.
Power Articulating Foot Platform ..........................$3,145Not covered by AADL
Manually Adjustable Center Mount .......................... $580Foot Platform, 12"W-20"W Static Seat
Manually Adjustable Center Mount .......................... $265Foot Platform, 12"W-20"W Power Positioning Seating
Manually Adjustable Center Mount .......................... $790Foot Platform, 20"W-24"W Static Seat
Manually Adjustable Center Mount .......................... $475Foot Platform, 20"W-24"W Power Positioning Seating
This rigging configuration causes no interference issues at this seat-to-floor height.This rigging configuration may have less than 1.75” clearance when fully extended and may interfere with the ground or reduce obstacle climbing ability.
Center Mount Foot Platform Compatibility Matrixfor TRU-Balance® 3
Power Reclineor Static Seat
Low Med. High Low Med. High Low Med. High
Power Tilt Power Lift
10”-16” Length Extension
13”-19” Length Extension
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Width Extension for 8”D Footplates ..........................$55Part: RIG152517
Width Extension for 11”D Footplates .........................$55Part: RIG152518
2” Bell-Shaped Length Extension ..............................$55Part: RIG152519Not compatible with width extensions. Can be used with 6” outside edge with 11” footplates.
4” Outside Edge (pair) ............................................$55Part: RIG152510Only available with 6”D footplates and 8”D footplate extension.
6” Outside Edge (pair) ............................................$55Part: RIG152516Available with 8”D and 11”D footplates and 11”D footplate extension.
Reversed Dartex Calf Pad Cover (pair) ...................... $150Small part: RIG133717. Large part: RIG133719
Center Mount Calf Support*Calf pads are standard with a power articulating foot platform. Select calf pads covers for additional charge. Calf pad and panel covers include 1/2” of soft visco foam.
Modular Footplate Extension ComponentsOptional. Assembly required. May require seating configuration adjustments to avoid front caster interference. Clinical justification required.
Additional Accessories
8"-12" Extension, 5"x6" FootplatesPart: RIG152577Not available with power articulating platform.
8"-12" Extension, 5"x8" FootplatesPart: RIG152578Not available with power articulating platform.
Heavy Duty, 70°, Drop-In, Swing-Away LegrestsSelect a configuration, a legrest with extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.
Accessories
Heavy Duty Elevating LegrestsSelect a configuration, a legrest upper, a legrest extension, and type of footplate. Left (L) and right (R) configurations are selected by checking the appropriate boxes.
Left and Right Legrests will match Left and Right Legrests will not match One Legrest (Left or Right as Marked)
6”Wx11”D1 .........................................$87.50 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797.May cause interference on seat widths less than 18".
8”Wx11”D2 .........................................$87.50 ea.Pair part: FRMASMB4744. Left: RIG137708. Right: RIG137709.May cause interference on seat widths less than 20".
Wheel Bumper(s) .......................................................................................................................... $15 ea.Pair part: WHLASMB1578. Left part: WHL169510. Right part: WHL169511
Angle Adjustable Footplate(s) with Heel Loops
Heavy Duty, Elevating Legrest(s) with Calf Pad(s) ................................................................................ $275 ea.Pair part: FRMASMB6702. Left: FRMASMB8444. Right: FRMASMB8445.
8”Wx11”D ..........................................$87.50 ea.Pair part: FRMASMB4744. Left: RIG137798. Right: RIG137799.May cause interference with seat widths less than 20"
Angle Adjustable Footplate(s) with Heel Loops
11”-14” LengthPart: FRMASMB4755. Left part: RIG138026. Right part: RIG138030For reinforced footplates only.
12”-14.5” LengthPart: FRMASMB4752. Left part: FRMASMB5391. Right part: FRMASMB4723For angle adjustable footplates only.
14”-17” LengthPart: FRMASMB4756. Left part: RIG138033. Right part: RIG138035For reinforced footplates only.
14.5”-18” LengthPart: FRMASMB4753. Left part: FRMASMB4724. Right part: FRMASMB5392For angle adjustable footplates only.
Lower Extension
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Page 13 of 13INFINFB3572/RevD/01OCT2018
SET LEGREST LENGTHREQUIRED with matching left and right legrest configuration. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. Reference the section’s compatibility matrix for legrest interference. Non-matching or individual legrest configurations lengths are not set by the manufacturer.
Set Legrest Length at:______ Part: PTOINDV#, see below
PROVIDER INSTALLED ACCESSORIESOptional. Multiple accessories can be mounted along the various tracks but some interference may occur. Standard battery and accessory pricing applies. Not covered by AADL.
TRU-Balance 3 Cup Holder ....................... $20For use with TRU-Balance 3 (track style) armrests.
Cup Holder (Tube-style Armrest) ............... $20For use with tube-style armrests.
TRU-Balance 3 Backpack Holder (Pair) (A) ....$42Not available with back cane option.
BATTERIESREQUIRED. Select a type of battery below or to omit the batteries. The powerchair requires 2 batteries. Standard battery and accessory pricing applies.
Battery InstallationPlease choose if batteries will be installed, if selected above.
Group 24, 70 Amp Gel Cell, UPG Battery .............. $460 ea.Part: BATGEL1004.
No batteries. Provider will assume responsibility of batteries.Part: Configuration selection
Group 24, 70 Amp Gel Cell, MK Battery ............... $460 ea.Part: BATGEL1009.
Install Batteries ........................................... No ChargePart: PTOINDV1675
Do Not Install Batteries .................................. No ChargePart: PTOINDV2008
SPECIALTY CONTROLSOptional. Select a type of specialty controls below or to refer to the specialty controls order form. Standard Stealth pricing applies.
Enhanced Display and EX SAJ Joystick
Black, Soft Touch ............................ Standard
Non-matching Joystick Shroud .................. $75Select color below. Not covered by AADL
Match Joystick Shroud to Base Color ........... $75Part: See color below. Not covered by AADL
Q-Logic 3 Enhanced Display ShroudRequired with Q-Logic 3 Enhanced Display selection above. Reference colors shown on page 2.
Q-Logic 3 Enhanced Display Kit .............$2,045Select a color option below. Includes enhanced display, flexible gooseneck and mounting bracket. Features: 3.5” LCD display; up to 5 profiles to control drive, seat, and auxiliary functions; Bluetooth connectivity for mobile devices and mouse emulation; integrated single switch scanner; IR controls.
Q-Logic 3 EX SAJ ................................. $850Must be used in conjunction with Enhanced Display or Q-Logic 3 Joystick.
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