MED bility m Page 1 of 14 26AUG2019 Quantum 4Front ™ Order Form with TRU-Balance ® 3 Positioning (AADL W751) Quantum ® Rehab FOR AADL USE ONLY 5096 South Service Road, Beamsville, ON L0R 1B3 Phone: 1-888-570-1113 | Fax: 1-866-514-1303 | Email: [email protected]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 . 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 at- tach 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 1-888-570-1113 if assistance is needed. Send the completed order form by fax (1-866-514-1303) 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. Account Number: ___________ Date: ________________ Provider Name: __________________________________ Contact: ________________________________________ Phone: ___________________ Fax: _________________ Email:__________________________________________ PO Number:_____________________________________ Marked for: _____________________________________ Ship to Address: _________________________________ City:_________________ Prov:______Postal:_________ Quantum 4Front ................................................................................................................................... $7,995 Part: Q4FRONT , Adult ADP: WP0001441, Pediatric ADP: WP0001442 BASE MODEL REQUIRED. 300 lb. weight capacity with standard 6mph programmable motors and 8 amp off board charger. Dimensions of base without leg- rests: 24.2”Wx45.7”L. PATIENT'S WEIGHT REQUIRED. The patient's weight is required to quote and order the power chair. Patient's Weight:________ Discount 8% MEDmobility AADL Vendor #0000612578-001
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MED bilitym Page 1 of 1426AUG2019
Quantum 4Front™ Order Form with TRU-Balance® 3 Positioning (AADL W751)
Quantum® Rehab FOR AADL USE ONLY 5096 South Service Road, Beamsville, ON L0R 1B3Phone: 1-888-570-1113 | Fax: 1-866-514-1303 | Email: [email protected]
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. 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 at-tach 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 1-888-570-1113 if assistance is needed. Send the completed order form by fax (1-866-514-1303) 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.
BASE MODELREQUIRED. 300 lb. weight capacity with standard 6mph programmable motors and 8 amp off board charger. Dimensions of base without leg-rests: 24.2”Wx45.7”L.
PATIENT'S WEIGHTREQUIRED. The patient's weight is required to quote and order the power chair.
FENDER LIGHTSREQUIRED. Fender lights are standard and will be automatically included unless omitted or if base mounted lights are selected. Standard battery and accessory pricing applies.
BASE MOUNTED FULL LIGHT PACKAGEOptional. Fender lights will omitted when a base mounted full light package is selected. Not available with Seat Mounted, full lighting package. Requires Q-Logic 3 Joystick for Full Light Package. Standard battery and accessory pricing applies.
Omit Fender Lights ....................................... No ChargePart: DGN1700032
Base Mounted Full Light Package ..................................................................................................................$770Part: ELE1700035
CASTER SENSORSREQUIRED. Delivers enhanced traction and tracking for smooth obstacle transitions. ADP: WEPQ
Back in Black ....................StandardPart: DGN164245-PBK1
Red Corvette .................. No ChargePart: DGN164245-PRD1
Electric Blue ................... No ChargePart: DGN164245-PBU9
White Satin ..................... No ChargePart: DGN164245-PWH2
Pretty in Pink .................. No ChargePart: DGN164245-PPK3
Night Train ..................... No ChargePart: DGN164245-PBK3
Deep Purple ................... No ChargePart: DGN164245-PPR5
Lime Light ...................... No ChargePart: DGN164245-PGN7
Grey Street ..................... No ChargePart: DGN164245-PSL3
Silver Bullet .................... No ChargePart: DGN164245-PSL7
Midnight Blue .................. No ChargePart: DGN164245-PBU10
Orange Crush .................. No ChargePart: DGN164245-POR6
Yellow Blaze ................... No ChargePart: DGN164245-PYL3
ANTI-TIPSREQUIRED.
Anti-tips included ................................................................................................................................Standard
No Anti-tips ......................................................................................................................................No ChargeOnly available with weight capacity less than 200 lbs. Lowest STF height only. Max Speed of 5mph (2.7 mph when elevated).
SUSPENSIONREQUIRED.
Standard ............................................................................................................................................Standard
Heavy Duty .......................................................................................................................................No Charge
JOYSTICK/SCIM 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 Form.
Q-Logic 3 Expandable Capacity Joystick .... $900Part: CTL167724ADP: WEX1Allows use of specialty controls and multiple actuators.
Q-Logic 3 Expandable Capacity Joystick .... $900for Full Light PackagePart: CTL167725ADP: WEX1Allows use of specialty controls, multiple actuators, and light packages.
No Joystick, Setup for Q-Logic 3 ElectronicsPart: Configuration selection.
Q-Logic 3 Expandable Capacity
Q-Logic 3 Joystick ShroudREQUIRED with Q-Logic 3 Joystick selection above. Reference colors shown on page 2.
Q-Logic 3 EX Joystick
Black, Soft Touch ......................................... No ChargePart: DGN124307
Non-matching Joystick Shroud ........................ No ChargePart: PTOINDV3422Select color below
Match Joystick Shroud to Base Color ...................StandardPart: PTOINDV3421
Red CorvettePart: DGN124336-PRD1
Electric BluePart: DGN124336-PBU9
Back in BlackPart: DGN124336-PBK1
Night TrainPart: DGN124336-PBK3
White SatinPart: DGN124336-PWH2
Pretty in PinkPart: DGN124336-PPK3
Deep PurplePart: DGN124336-PPR5
Lime LightPart: DGN124336-PGN7
Grey StreetPart: DGN124336-PSL3
Silver BulletPart: DGN124336-PSL7
Midnight BluePart: DGN124336-PBU10
Orange CrushPart: DGN124336-POR6
Yellow BlazePart: DGN124336-PYL3
JOYSTICK HANDLESOptional. The optional handle will be mounted to the joystick and the standard handle will be shipped with the unit. Standard battery and ac-cessory pricing applies.
Retract4 Mount ................................... $450Q-Logic Part: MEC138860. Full 180° of movement that translates into multi-position use, straight, right offset, left offset, or fold away. Joy-stick orientation varies as bracket is adjusted.
Multi-axis Mount ...................................$100Q-Logic Part: ACC131216. Allows height adjustment of joystick.
Stealth Swing-Away/Flip Down Bracket ........$300QL3 SAJ: ST-TWBM480CJ-Q. QL3 Joystick Part: ST-TWBM480QL-Q. ADP: WEPMAllows the joystick to pivot to side of armrest, or flip-down if bracket is adjusted.
Specialty Joystick MountsSelect a bracket and side to mount it. Standard Stealth pricing applies.
Left Side MountPart: PTOINDV1225
Right Side MountPart: PTOINDV1226
Specialty Mount Side
Swing-Away (Retractable) Bracket (ADP: WEPM)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.
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, 1” Offset, Left Side Mount ..... $265NE/NE+ Part: ACC142747 ADP:WEPMQ-Logic: ACC142742
Swing-away, 1” Offset, Right Side Mount .... $265NE/NE+ Part: ACC142748 ADP: WEPMQ-Logic: ACC142743
JOYSTICK MOUNTING BRACKETS continued
ELECTRONICS ACCESSORIESOptional. Standard battery and accessory pricing applies.
USB Mobile Device Charger ......................$185Part: ELE124122Can charge 1 device. A multiplier harness is required and must be added when a Static Seat or Power Tilt Only seating system is chosen. The selection of more than 3 modules requires an additional multiplier.
USB MediaDevice Charger
TRU-Balance® 3 Configuration
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. Seating discount applies.
TRU-Balance 3 Static Seat ...................................$1,045ADP: WEPNStandard with Angle Adjustable Back Canes.
TRU-Balance 3 Power Tilt ....................................$6,245Part: PTOINDV3443. ADP: WP0001162 50° Center of Gravity (CG) power tilt seating system.
TRU-Balance 3 Power Recline ..............................$7,875Part: PTOINDV3444. ADP: WP0001163 175° of power recline.
TRU-Balance 3 Power Tilt & Recline ......................$13,125Part: PTOINDV3446. ADP: WP0001164 50° CG power tilt with 175° of power recline. Full drive lockout at 20°.
TRU-Balance 3 10” Lift ......................................$2,495Part: PTOINDV3773 22”W x 22”D maximum seat size. Not available with manual recline. A control type in Power Positioning Electronics section, page 10, must be selected. iLevel discount applies.
Attendant Manual Recline ..................................... $795Part: PTOINDV3501. ADP: WEPINot available with NE+ joystick with Tilt through toggle. Available with Static Seat or Power Tilt. Not available with Power Lift.
10” Power Lift or Manual ReclineOptional. Select one option below.
WC-19 Occupied Transit Option...............................$400To determine if your chair is WC-19 compliant (occupied), please re-fer to this website: http://wc-transportation-safety.umtri.umich.edu/crash-tested-product-lists/wheelchairs
Transit KitOptional. The 4Front is standard with Unoccupied Transit Loops. 60” Sure-Lok Lap Belt is required with Occupied Transit Option.
Seat DimensionsREQUIRED with seat selection. Select width and depth package and enter or check desired set width and depth in that package range, available in 1” increments. Configurations disallowed or not shown may be available through special order. 12” Width is not available with 16” and 17” Depth. 13” and 15” widths are only available with non-matching back width. Maximum seat size is 22"W x 22"D. Parts: See XRef: TB3SPACK
Set Width at:______ Part: SETWDTH#, see below
Set Depth at:______ Part: SETDPTH#, see below
(Maximum Width is 22")
Seat to Floor HeightREQUIRED. Select a seat to floor height compatible with the seat functions previously selected. Seat to floor height stated below is based on unoccupied height. Actual height may vary depending on weight of patient.
Lowest Standard TowerStatic: 15'', PP: 17.75''
Lowest Extended TowerStatic only: 18''
Middle Standard TowerStatic: 16'', PP: 18.75''
Middle Extended TowerStatic only: 19''
Highest Standard TowerStatic: 17'', PP: 19.75''
Highest Extended TowerStatic only: 20''
12”-16” Width PackageOnly available with 12-16" Depth Package. AFP/Center Mount N/A when this option is selected.
Seat WidthADP for widths over 18": WEPA. Armrests, when set in their normal position, add 5.5" to the overall seat width selected. Minimum overall seat width when using TB3 flip-back armrests is 21.75".
Flip Forward ............................................... No ChargePart: MEC140272
1” Endo ..................................................... No ChargePart: MEC141455
2” Endo ..................................................... No ChargePart: MEC141456
Back CaneSelect with Back Cane Option selected above.
Back Cane HeightSelect with Back Cane Option selected above.
16”H CanePart: FRMASMB15834
17”H CanePart: FRMASMB15835
20”H CanePart: FRMASMB15838
21”H CanePart: FRMASMB15839
24”H CanePart: FRMASMB15842
25”H CanePart: FRMASMB15843
Back SelectionRequired. Match choice in this section with the options in the back cushion configuration section.
Static Back ........................................................ $735Non-power back selection provides 20° of limited recline adjustment (-5/ +15) via gas strut within back cover. Select a back cushion configuration in the sub-sequent section. Required when using Flip-back armrests.
Back Cane Option, Omit ...................................StandardBack Pan/ CushionSelect cane type and the back cane height below.
Flip Forward Back ............................................... $735Only available with 2-post, flip back or pediatric armrests. Not available with 12”-14” width or with attendant manual recline. Select a back cushion type in the subsequent section.
Back Cushion ConfigurationRequired except when back cane option selected. Select a configuration type and applicable dimensions. See the Sport, Q-Back, and TRU-Com-fort back availability chart for stock order back size ranges. Other size backs may be available with Special Order and extended lead time. Standard ADI pricing applies.
Sport Back.................................................. No ChargeComplete following width package and size.
Omit Back Pan/Cushion .................................. No ChargeSelect a following width package.
Aftermarket Back Interface ............................ No ChargeEnter the preset back width below. Overall seat depth may need to be adjusted to accommodate certain backs. May interfere with gel/wa-terfall armpads and arm through. Does not include brackets to mount aftermarket backs. A Special Order is required on back widths less than 16”.
Match Seat Width SelectionsPart: PTOINDV3468
10”W-14”W PackagePart: Configuration selection, back cushions
16”W-20”W PackagePart: Configuration selection, back cushions
20”W-24”W PackagePart: Configuration selection, back cushions
Back Cushion WidthAvailable with +/-4” of seat width.
Tilt or Static Width Recline Width
Sport, Q-Back, and TRU-Comfort Back Availability Chart
Ove
rall
Hei
ght
Sport or TRU-Comfort BackSport BackSport, Q-Back, or TRU-Comfort
Set Width at:______ Part: PTOINDV#, see below
12” W(#3562)
14” W(#3563)
16” W(#3564)
17” W(#3565)
18” W(#3566)
19” W(#3567)
20” W(#3568)
21” W(#3569)
22” W(#3570)
24” W(#3571)
Back Overall HeightPower Lift and Tilt Package available height range: 14”-25”H. Odd heights include 4” gap and even heights include 3” gap between seat pan and bottom of back cushion.Power Recline Packages available height range: 19”-28”H. Odd heights include 6” gap and even heights include 7” gap. See the Sport and TRU-Comfort back availability chart for stock order back size ranges.
Set Overall Height at:______ Part: SETHGTH#, see below
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.
Additional TRU-Balance 3 Back OptionsOptional.
TRU-Comfort Lateral Positioning Wedge, pair ..... No ChargePart: SET123465ADP: SELND0005x2Available 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.
Privacy Flap, 12.75” ............................................. $40Part: DWR1044E456AStandard on recline seating systems.
Red CorvettePart: DGN148034
Electric BluePart: DGN148076
Back in BlackPart: DGN148032
Night TrainPart: DGN1706558
White SatinPart: DGN148075
Pretty in PinkPart: DGN148045
Deep PurplePart: DGN148046
Lime LightPart: DGN148036
Grey StreetPart: DGN148074
Silver BulletPart: DGN148047
Midnight BluePart: DGN148035
Orange CrushPart: DGN148038
Yellow BlazePart: DGN148077
TRU-BALANCE 3 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)
TRU-Balance 3 Flip-Back, 8”-16”H .................. $145 ea.Part: See XRef. Must pick Static Back Spine. Not available with back canes
Two-Post ArmrestsSelect the armrest and set the left and right heights in the following section. These armrests may interfere with offset backs/ back canes.
2-Post, Flip Back, Height Adjustable, and Removable Armrests (9”-13” Height) ................................................... $145 ea.Not available with a depth less than 16”. Required with flip forward back and laptrays.
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)
10”-14”H, Single Post, Height Adjustable, ............ $130 ea.Removable, Heavy Duty (Sold as pair)
TRU-BALANCE 3 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” HPTOINDV3535
Stealth 14” Comfort Plus (CP150) ..............$190Part: INDPART2327ADP: SEHNS3020 (Includes bracket)
Pediatric Comfort Plus (6”Wx4.5”H) ..........$190(CPN350)Part: SETHEAD1069
Stealth Small Contoured (9.75”Wx3”H) ........$80(STL-OTSM250)Part: SETHEAD1052
Stealth Large Contoured (11”Wx6”H) (B) .....$100(STL-OTLG150)Part: SETHEAD1053
Falcon Gel, Full Length Left and Right ............................... $300Part: ARM136438
Falcon Gel, Full Length Left, Desk Length Right ................... $250
Part: ARM136442
Falcon Gel, Desk Length Left, Full Length Right ................... $250Part: ARM136439
Flat Style, Falcon Gel, Full Length Left and Right ................. $300Part: ARM136417
Flat Style, Falcon Gel, Full Length Left, Desk Length Right ..... $250Part: ARM136426
Flat Style, Falcon Gel, Desk Length Left, Full Length Right ..... $250Part: ARM136418
Flat Style, Falcon Gel, Desk Length Left and Right ................ $200Part: ARM136416
Tube Style, Falcon Gel, Full Length Left and Right ................ $300Part: ARM1806805
Tube Style, Falcon Gel, Full Length Left, Desk Length Right ... $250Part: ARM1806940
Tube Style, Falcon Gel, Desk Length Left, Full Length Right ... $250Part: ARM1806939
Tube Style, Falcon Gel, Desk Length Left and Right .............. $200Part: ARM1806933
Gel ArmpadsSold only in pairs. Armpads are 3” wide. Manufacturer part number for full length is 314G and desk length is 310G.a. Falcon Gel Armpads for TRU-Balance 3 Armrests
b. Falcon Gel Armpads for 2-post & HD armrests
TRU-BALANCE 3 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.
Foam Armpads
No Armpad Selection and/or See Positioning Components Page or Order Form .....................................................................No Charge
Straight, Armpad .......................................StandardPart: See XRef
Waterfall, Armpad .................................... No ChargePart: See XRef
TRU-BALANCE 3 POWER POSITIONING ELECTRONICSRequired. Select the desired control type for the seating system. Please note the available actuator controls.
TRU-BALANCE 3 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.
Push Handles (pair) ...............................$140Part: ACC147772Not available with oxygen holder, back cane option, or vent tray. Required with attendant manual recline.
Accessory Bar ....................................... $90Part: MEC125098Standard 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.
Switch Controls
iAccessFlat Button
iAccessToggle Button
Compact and Trilogy
TRU-BALANCE 3 SEAT MOUNTED, LED LIGHT PACKAGEOptional. Requires Q-Logic Joystick for full light package. Not available with base mounted full lighting. Standard battery and accessory pricing applies.
Seat Mounted, LED Light Package ............................ $770Part: ELE131477
Through Toggle Control (Tilt Only) ................... No Charge
Single Power Electronics (includes AM1)
Through Q-Logic Joystick ................ No Charge
Single/Multiple Power Electronics (includes AAM)
Through Q-Logic 3 Controller and ............ $625Interface ADP: SECX15005
Through Flat Button iAccess and ............ $1,525Q-Logic 3 Controller and InterfaceADP: SECX15005Programmable up to 15 functions. Only available with TRU-Balance 3 armrests.
Through Toggle Button iAccess and ........ $1,525Q-Logic 3 Controller and InterfaceADP: SECX15005Programmable up to 15 functions. Only available with TRU-Balance 3 armrests.
LAP BELTSRequired. Select a lap belt below. Standard Stealth pricing applies.
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 Calf SupportCalf 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.
Additional Accessories
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 ArticulatingFoot Platform
Power Articulating Foot Platform ..........................$3,145ADP: SEFX13010
Manually Adjustable Center Mount .......................... $265Foot Platform
Center Mount Lower Extension
8”-12” ExtensionN/A with Power Articulation.
10”-16” Extension 13”-19” Extension
Set Length at:______Center Mount Footplates
5”x8” FootplatesStd with Width Extension
5”x11” FootplatesStd with Width Extension
No interference issues at this seat-to-floor height.
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 Matrix
TRU-Balance® 3Power Recline
Low Medium High Low Medium High Low Medium High
TRU-Balance® 3Power Tilt
TRU-Balance® 3Power Lift
10”-16” Length Extension
13”-19” Length Extension
Small Calf Pad (pair) 6”Wx6”H ................................ $210
Large Calf Pad (pair) 8” taper to 6”Wx8”H ................ $210
Small Calf Panel 18”Wx8”H ................................... $210ADP: SEFND0010
Large Calf Panel 24”Wx8”H ................................... $265ADP: SEFND0010Only available on widths of 20” or greater.
Reversed Dartex Calf Pad or Panel Cover (pair) .......... $150
70° Power Articulating, Swing Away Legrests (ADP: SEXF13005)4” of articulating range. Be sure power legrest control has been selected in previous section. Select an upper, lower extension, and footplate. Left (L) and right (R) configurations are selected by checking the appropriate boxes.Configuration Verification
Left and Right Legrests will Match Left and Right Legrests will not match One Legrest (Left or Right as Marked)
TRU-BALANCE 3 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.
MED bilitym Page 11 of 1426AUG2019
LEGRESTS continued
Accessories
60°-90° Swing-Away LegrestsAdjustable in 5° increments. Select a configuration, a legrest upper, a legrest extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes. Select legrest length in following section.
Angle Adjustable Footplate (ADP: WEPJ)¹The 6”x11” footplates may cause interference with seat widths less than 18”. ²The 8”x11” footplates may cause interference with seat widths less than 20”.
Calf Pad (pair) 6”Wx6”H ................................ No Charge Gel Padded Knee Abductor Buttons (pair) ................. $125
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.This rigging configuration does not work with this seat-to-floor height.
70° Power Articulating,Swing-Away Legrest Compatibility Matrix
TRU-Balance® 3Power Recline
Low Medium High Low Medium High Low Medium High
TRU-Balance® 3Power Tilt
TRU-Balance® 3Power Lift
Angle Adjustable,11” - 13”
Angle Adjustable,14.5” - 18”17.5” - 21”
Angle Adjustable,
Configuration VerificationLeft and Right Legrests will match Left and Right Legrests will not match One Legrest (Left or Right as Marked)
Swing-Away Legrest Upper60°-90° Swing-Away Legrest ....................................................................................................................$285Lower extensions with minimum 11” length utilize a short style legrest upper.
Lower Extension11”-13” LengthN/A with Multi-axis
11”-16.5” LengthOnly with Multi-Axis
13”-16.5” LengthN/A with Multi-Axis
15.5”-19.5” Length
Set Length at:______Extruded Footplate(s)
7.25”Wx6”D Extruded Footplate ....................Standard 8.5”Wx6”D Extruded Footplate .....................StandardMay cause interference on seat widths less than 18.”
Angle Adjustable or Multi Axis Selection (ADP: WEPJ)
Angle Adjustable with Heel Loops ................$87.50 ea.(Select footplate size)
Angle Adjustable or Multi-Axis Footplate Size¹The 6”x11” footplates may cause interference with seat widths less than 18”. ²The 8”x11” footplates may cause interference with seat widths less than 20”.
60°-90° Swing-Away Legrest AccessoriesHeel Loops (pair) ..................................................$35Part: FRMASMB7873 Standard on angle adjustable and multi-axis footplates.
Gel Neoprene Footrest Sleeve (pair) ........................ $130Part: INDPART2243
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.This rigging configuration does not work with this seat-to-floor height.
Elevating Legrests (ADP: WEPK)Select 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.Configuration Verification
Left and Right Legrests will match Left and Right Legrests will not match One Legrest (Left or Right as Marked)
Elevating LegrestElevating Legrest Assembly .....................................................................................................................$550Select lower extension and footplates
Angle Adjustable with Heel Loops .................$87.50 ea(Select footplate size below)
Angle Adjustable Size¹The 6”x11” footplates may cause interference with seat widths less than 18”. ²The 8”x11” footplates may cause interference with seat widths less than 20”.
PROVIDER INSTALLED TRU-BALANCE 3 ACCESSORIESOptional. Multiple accessories can be mounted along the various tracks but some interference may occur. Standard battery and accessory pricing applies.
BATTERIESRequired. Select a type of battery below, or to omit the batteries. The powerchair requires 2 batteries. Standard battery and accessory pricing applies. 4Front powerchair requires batteries with flat-top terminals. Regular batteries will not fit in the battery tray.
Battery InstallationPlease choose if batteries will be installed, if selected above.
Install Batteries ........................................... No Charge Do Not Install Batteries .................................. No Charge
Group 24, 70 Ah Gel Cell Battery ....................... $510 ea.Part: BAT166005
Group 34, 60 Ah Gel Cell Battery .......................$400 ea.Part: BATGEL1006
No batteries. Provider will assume responsibility of batteries.Part: Configuration selection
SPECIALTY CONTROLSOptional. Select a type of specialty controls below or to refer to the specialty controls order form. Standard Stealth pricing applies.
Enhanced Display
EX SAJ
Enhanced Display and EX SAJ JoystickQ-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.
Q-Logic 3 Enhanced Display ShroudRequired with Q-Logic 2 Enhanced Display selection above. Reference colors shown on page 2.
Black, Soft Touch .......................... No Charge
Non-matching Joystick Shroud ......... No ChargeSelect color below
Match Joystick Shroud to Base Color .... StandardPart: See color below.
