Page 1 of 16INFINFB4241/RevC/03AUG2021
Q6 Edge® HD Order Form with TRU-Balance® 3 Positioning
Quantum® Rehab401 York Ave., Duryea, PA 18642Phone: 866-800-2002 | Fax: 866-707-3422 | Email: [email protected]
Account Number: ___________ Date: ________________
Provider Name: __________________________________
Contact: ________________________________________
Phone: ___________________ Fax: _________________
Email: __________________________________________
PO Number: _____________________________________
Marked for: _____________________________________
Ship to Address: _________________________________
City: _____________________ State: ______ Zip: ______
Weight:________ Height:________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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: ________
This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. Com-plete 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 866-800-2002 if assistance is needed. Send the completed order form by fax (866-707-3422) 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. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for deter-mining the appropriate billing codes when submitting for insurance reimbursement. Payer coding, coverage, and bundling guidelines may apply. 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.
Thank you for choosing Quantum!
INTRODUCTION
PATIENT INFORMATION
1. BASE MODELREQUIRED. Select a group 3 power base. 450 lb. weight capacity with standard 4.7 mph programmable motors, 8 amp off board charger, and unoccupiedtransit loops. Dimensions of base without legrests: 26”Wx36.75”L.
Quantum Q6 Edge HD 3HD-SS ........................................$8,595Part: Q6 EDGEHD 3HD-SS. HCPCS: K0850Solid seat pan standard with no power option.
Quantum Q6 Edge HD 3SPHD-SS .....................................$8,595Part: Q6 EDGEHD 3SPHD-SS. HCPCS: K0858Single power option.
Quantum Q6 Edge HD 3MPHD-SS ....................................$8,595Part: Q6 EDGEHD 3MPHD-SS. HCPCS: K0862Multiple power option.
Page 2 of 16INFINFB4241/RevC/03AUG2021
Account Number: ___________ Date: ________________ Marked for: _____________________________________2. BASE COLORREQUIRED. Select one shroud color. Colors shown here may differ from actual product depending on monitor/printer calibration used.
Red CorvettePart: DGN169178-PRD1
Electric BluePart: DGN169178-PBU9
Back in BlackPart: DGN169178-PBK1
Night TrainPart: DGN169178-PBK3
Pretty in PinkPart: DGN169178-PPK3
Evolution OrangePart: DGN169178-POR7
Deep PurplePart: DGN169178-PPR5
Grey StreetPart: DGN169178-PSL3
Midnight BluePart: DGN169178-PBU10
Green MachinePart: DGN169178-PGN11
3. FENDER LIGHTSOptional. Fender lights operate by pressing included single switch button. Fender lighting is not available with NE 4-Key Joystick or Single Actuator Control through Toggle Box.
6. BATTERIESOptional. The powerchair requires 2 batteries and will be installed if ordered.
Group 24, 70 Amp Gel Cell, Interceptor Battery ............. $365 ea.Part: BAT1704614. HCPCS: E2363
Group 24, 70 Amp Gel Cell, MK Battery ........................ $495 ea.Part: BATGEL1009. HCPCS: E2363
3" x 14” Run Flat Tires .............................................. StandardPart: PTOINDV3510
3" x 14” Flat Free Tires ........................................... No ChargePart: WHL124116 x2
3" x 14” Pneumatic Tires ......................................... No ChargePart: WHL124117 x2
4” x 14" Flat Free, Knobby, Extended Traction Tires .... $275.50 ea.Part: WHL121698 x2
4” x 14" Pneumatic, Knobby, Extended Traction Tires .. $275.50 ea.Part: WHL121703 x2
5. DRIVE WHEELSREQUIRED. Select a type of drive wheels and accent color. Knobby tires increase overall base width by 1.5”.
5.1. Drive Wheels
Electronics section continued on following page.
5.2. Drive Wheel Accent ColorOptional. Not available with knobby tires.
Switch Fender Lights without Lift System ........................... $250Part: XRF000177
Switch Fender Lights with Lift System ........................ No ChargePart: DGN154117
Back in Black Accent Color..............$59.95Part: XRF000179
Red Corvette Accent Color .............$59.95Part: XRF000180
Electric Blue Accent Color ..............$59.95Part: XRF000188
Night Train Accent Color ................$59.95Part: XRF000181
Pretty in Pink Accent Color .............$59.95Part: XRF000185
Evolution Orange Accent Color ........$59.95Part: XRF000186
Deep Purple Accent Color ...............$59.95Part: XRF000184
Grey Street Accent Color ................$59.95Part: XRF000182
Midnight Blue Accent Color .............$59.95Part: XRF000187
Green Machine Accent Color ...........$59.95Part: XRF000190
1. Optional Mounting Bracket
4. QUANTUM BACKUP CAMERAOptional. The backup camera may interfere with armrest mounted accessories such as media device holder.
Quantum Backup Camera ............................................................................................................. $350Part: MEC1910365
Backup Camera Headrest Bracket .....................................................................................................$20Part: MEC1910373Works with .5" x .5" vertical supports only.
Backup Camera
NE+ 6 Key Joystick
NE 4-Key Joystick ....................................StandardPart: CTLDC1554Available with Static Seat or Tilt Only through Toggle.
NE+ 6-Key Joystick ................................No ChargePart: CTLDC1560Control of one actuator through Joystick on single power base model (3SPHD-SS) only.
No Joystick, Setup for NE+ Joystick ...........No ChargePart: XRF000009
NE+ 6-Key Joystick ......................................$200Part: XRF000001Control up to 2 actuators through joystick.
NE+ 8-Key Joystick .......................................$400Part: CTLDC1561Control up to 2 actuators and LED, Full Light Package through joystick.
7.1a. Non-Expandable ControlsSelect a joystick below or omit selection if another controller type is desired. Non-expandable does not allow supplementary drive controllers.
7. 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.
Page 3 of 16INFINFB4241/RevC/03AUG2021
Left Side MountPart: PTOINDV1225
Right Side MountPart: PTOINDV1226
9.2. Joystick Mount Location
9.1c. Specialty Joystick MountsSelect a bracket and side to mount it.
Retract4 Mount ............................................$350Part: XRF000003. HCPCS: E1028Full 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 .......................................... $120Part: XRF000004Allows height adjustment of joystick.
Stealth Swing-Away/Flip Down Bracket ..........$294.25Part: XRF000005. HCPCS: E1028Allows the joystick to pivot to side of armrest,or flip-down if bracket is adjusted.
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Black, Soft Touch ................. StandardPart: DGN124307
Non-matching Shroud ...................$60Part: PTOINDV3422Select color below
Match Shroud .............................$60Part: PTOINDV3421
Red CorvettePart: DGN124336-PRD1
Electric BluePart: DGN124336-PBU9
Back in BlackPart: DGN124336-PBK1
Night TrainPart: DGN124336-PBK3
Pretty in PinkPart: DGN124336-PPK3
Evolution OrangePart: DGN124336-POR7
Deep PurplePart: DGN124336-PPR5
Grey StreetPart: DGN124336-PSL3
Midnight BluePart: DGN124336-PBU10
Green MachinePart: DGN124336-PGN11
1. Q-Logic 3 Required ComponentsQ-Logic 3 expandable controls require the controller module and expandable harness below. If a Q-Logic joystick or specialty control is selected later in this form, Customer Service will quote the order with these items.
2. Q-Logic 3 Joystick
7.1b. 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.
7.2. Q-Logic 3 Joystick ArmorREQUIRED with Q-Logic 3 Joystick selections above. Reference colors shown on page 2.
8. 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 in section 7.1b. The optional handle will be mounted to the joystick and the standard handle will be shipped with the unit.
Joystick Handles
Joystick mounting brackets section continued on following pages.
Q-Logic 3 EX Controller Module .......................$695Part: XRF000002. HCPCS: E2377
Q-Logic 3 Expandable Controller Harness ...........$425Part: XRF000264. HCPCS: E2313
Mushroom Handle (B) ..................................... $85Part: ACCASMB1860. HCPCS: E2323
Chin Cup (C) ................................................. $85Part: ACCASMB1861. HCPCS: E2323 (E2324 when chin control)
T-Bar (D) .................................................... $120Part: ACCASMB1858. HCPCS: E2323
Medium Ball Handle (E) ................................... $65Part: ACCASMB1859. HCPCS: E2323
Soft Ball Handle (F) ........................................ $65Part: ACCASMB1856. HCPCS: E2323
Extended I-Handle (G) .................................... $85Part: ACCASMB1857. HCPCS: E2323
Bodypoint 3” Goal Post Handle ......................... $99Part: PLSKNCP1057. HCPCS: E2323
Bodypoint 4” Goal Post Handle ......................... $99Part: PLSKNCP1058. HCPCS: E2323
Q-Logic 3 Carrot Handle (A) .....................No ChargePart: DGN124308
7. ELECTRONICS continued
Q-Logic 3 Joysticks
3 EX 3eQ-Logic 3e Joystick ......................................$700Part: CTL1910600Can operate full light package. Not available with alter-native or specialty controls.
Q-Logic 3 EX Joystick ....................................$800Part: CTL167724
Q-Logic 3 EX Joystick for Full Lights .................$800Part: CTL167725
No Joystick, Setup for Q-LogicPart: XRF000010
9.1a. Fixed, In-line Joystick BracketFixed, In-line, Bracket for Q-Logic 3 ............StandardPart: FRMASMB10617
Fixed, In-line, Bracket for NE/NE+ ...............StandardPart: FRMASMB12744
9.1b. Swing-Away (Retractable) Joystick BracketAllows the joystick to retract to the side of the armrest while maintaining the same joystick orientation.
Swing-away, Q-Logic 3 ...................................$280Part: ACC1908434. HCPCS: E1028
Swing-away, NE/NE+ ......................................$280Part: ACC1908437. HCPCS: E1028
Swing Away Joystick
Multi-Axis JoystickMount
Retract4
9. JOYSTICK MOUNTING BRACKETSOptional. Select a mount to be used with a joystick selected in previous section.
Page 4 of 16INFINFB4241/RevC/03AUG2021
Spectrum Foam SPP, Matching Seat SizeReference part: XRF000112. MSRP: $460/$530
Stealth Spectrum Foam SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner.Part series: ST-SPCFSPPXXYY. HCPCS: E2607/E2608
Solution SPP, Matching Seat SizeReference part: XRF000113. MSRP: $375/$430
Stealth Solution SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner.Part series: ST-SOLSPPXXYY. HCPCS: E2607/E2608
Stealth Essence SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover.Part series: ST-ESSSPPXXYY. HCPCS: E2607/E2608
Essence SPP, No Wedge, Matching Seat SizeReference part: XRF000118. MSRP: $400/$500
Essence SPP, Small Wedge, Matching Seat SizeReference part: XRF000119. MSRP: $435/$535
Essence SPP, Medium Wedge, Matching Seat SizeReference part: XRF000120. MSRP: $465/$565
Essence SPP, Large Wedge, Matching Seat SizeReference part: XRF000121. MSRP: $495/$595
10.8. Matching Seat CushionOptional. Specific cushion/component sizes available, part numbers, weight capacities, MSRP, HCPCS code, and special order cushions can be found on the re-spective complete Stealth Cushion Order Forms. This section allows a quick selection of a single cushion that matches the seat pan width and depth. See specific order form for non-matching sizes, alternate covers and liners, or additional covers and liners.
Simplicity G, Matching Seat SizeReference part: XRF000111. MSRP: $110/$165
Stealth Simplicity G CushionGeneral use cushion with Stealth Tek 2, 2-way stretch, breathable cover.Part series: ST-SIMGXXYY. HCPCS: E2601/E2602
Glacial SP, Matching Seat SizeReference part: XRF000114. MSRP: $330/$440
Stealth Glacial SP CushionSkin protection with Coolcore, 4-way stretch, breathable cover.Part series: ST-GLSPXXYY. HCPCS: E2603/E2604
Premiere P, Matching Seat SizeReference part: XRF000122. MSRP: $325/$475
Stealth Premiere P CushionPositioning with Coolcore, 4-way stretch, breathable cover.Part series: ST-PREMPXXYY. HCPCS: E2605/E2606
Zen SP, Matching Seat SizeReference part: XRF000115. MSRP: $315/425
Stealth Zen SP CushionSkin protection with Coolcore, 4-way stretch, breathable cover.Part series: ST-ZENSPXXYY. HCPCS: E2603/E2604
10.7. Seat to Floor HeightREQUIRED.
Lowest Seat to FloorPart: PTOINDV3558
Middle Seat to FloorPart: PTOINDV3559
Highest Seat to FloorPart: PTOINDV3560
Account Number: ___________ Date: ________________ Marked for: _____________________________________
10.1. TRU-Balance 3 ConfigurationTRU-Balance 3 Static Seat ............................................$2,295Part: PTOINDV344220° of limited recline adjustment (-5/ +15) via gas strut within back cover.
TRU-Balance 3, Heavy Duty, Power Tilt ........................... $7,995Part: PTOINDV3643. HCPCS: E100250° Center of Gravity (CG) power tilt seating system.
TRU-Balance 3 Heavy Duty, Power Recline .......................$8,595Part: PTOINDV3645. HCPCS: E1004175° of power recline.
TRU-Balance 3 Heavy Duty, Power Tilt & Recline ............. $12,895Part: PTOINDV3644. HCPCS: E100750° CG power tilt with 175° of power recline. Full drive lockout at 20°.
TRU-Balance 3 Seating section continued on following pages.
10.2. 10" Power LiftOptional.
TRU-Balance 3, Heavy Duty, 10” Power Lift with iLevel® and Fender Lights ............................................ $2,600Part: PTOINDV3797. HCPCS: E2300400 lb weight capacity. 24”W x 24”D maximum seat size. Includes fender lights found in section 5.
10.3. Seat WidthREQUIRED. Maximum non-lift seat width is 32"W. *Widths over 24" are not available with 10" power lift. Part number is SETWDTH plus number following # below.
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)
10.4. Seat Width PackageREQUIRED.
20”-24” Width PackagePart: XRF000158
24”-28” Width PackagePart: XRF000192
28”-32” Width PackagePart: XRF000193
16”-20” Depth PackagePart: XRF000013Minimum Seat Depth is 20"
20”-24” Depth PackagePart: XRF000159Use with 25" Depth
20” D(#1010)
21” D(#1011)
22” D(#1012)
23” D(#1013)
24” D(#1014)
25” D(#1060)
10.6. Seat Depth PackageREQUIRED.
10.5. Seat DepthREQUIRED. Maximum seat depth is 25". Part number is SETDPTH plus number following # below.
10. TRU-BALANCE® 3 SEATING - Quantum Intelligent Systems™REQUIRED. Maximum seat size is 32"W x 25"D.
TRU-Balance 3Seat to Floor Heights
18.5” 19.5” 20.5”
16.5” 17.5” 18.5”
Low Med High
Tilt, Tilt & Recline, Lift
Static Seat, Recline
Page 5 of 16INFINFB4241/RevC/03AUG2021
TRU-Comfort 4 Back Cushion, 20” Width or Less .......................................................................................................................$675HCPCS: E2620. Select size below. Height is overall. Part number is SET plus number following #.
1b. TRU-Comfort Back Selection
Tilt:16"-17"H,Recline:19"-20"HPart: #124601
Tilt:18"-19"H,Recline:21"-22"HPart: #124602
Tilt:20"-21"H,Recline:23"-24"HPart: #124603
Tilt:22"-23"H,Recline:25"-26"HPart: #124605
Tilt:16"-17"H,Recline:19"-20"HPart: #123655
Tilt:18"-19"H,Recline:21"-22"HPart: #124576
Tilt:20"-21"H,Recline:23"-24"HPart: #124578
Tilt:22"-23"H,Recline:25"-26"HPart: #124597
Tilt:24"-25"H,Recline:27"-28"HPart: #124599
Tilt:16"-17"H,Recline:19"-20"HPart: #124606
Tilt:18"-19"H,Recline:21"-22"HPart: #124609
Tilt:20"-21"H,Recline:23"-24"HPart: #124611
Tilt:22"-23"H,Recline:25"-26"HPart: #124613
Tilt:24"-25"H,Recline:27"-28"HPart: #124619
18" Wide, 16"-20"Width Package:
19" Wide, 16"-20"Width Package:
20" Wide, 16"-20"Width Package:
Tilt:16"-17"H,Recline:19"-20"HPart: #124607
Tilt:18"-19"H,Recline:21"-22"HPart: #124610
Tilt:20"-21"H,Recline:23"-24"HPart: #124612
Tilt:22"-23"H,Recline:25"-26"HPart: #124618
Tilt:24"-25"H,Recline:27"-28"HPart: #124623
20" Wide, 20"-24" Width Package:
10.11. Back Cushion ConfigurationREQUIRED. Select a configuration type and applicable dimensions. See the Sport, Q-Back, and TRU-Comfort back availability chart for stock order back size ranges. Other size backs may be available with special order and extended lead time.
Sport Back ........................................................... No ChargePart: XRF000017Complete following width package and size.
Omit Back Pan/Cushion ........................................... No ChargePart: PTOINDV1287Select a following width package.
After-market Back Interface ........................................... $200Part: XRF000018Select a back width within a range of 16"-24"W. Overall seat depth may need to be adjusted to accommodate certain backs. May inter-fere with gel/waterfall armpads and arm through. Does not include brackets to mount after-market backs.
10.10. Back Cane Selection (Back Cane Option Only)REQUIRED when Back Cane Option is selected above. Select type and height of back canes.
2. Back Cane Height
1. Back Cane TypeAngle Adjustable ...................No ChargePart: MEC140266
1” Endo....................................... $70Part: XRF000269
2” Endo ...................................... $70Part: XRF000271
16” High CanePart: FRMASMB15834
17” High CanePart: FRMASMB15835
20” High CanePart: FRMASMB15838
21” High CanePart: FRMASMB15839
24” High CanePart: FRMASMB15842
25” High CanePart: FRMASMB15843
10.9. Back Type SelectionREQUIRED. Match choice in this section with the options in the following back cushion configuration section.
TRU-Balance 3 Back Assembly (Static Back)Part: XRF000194Select a back cushion configuration in the subsequent section.
Back Cane OptionPart: XRF000015Available only with TRU-Balance 3 Static Seat and Power Tilt selec-tions. Select back cane type, back cane height, and back cushion con-figuration.
Flip Forward Back..........................................................$175Part: XRF000220Available with Static Seat and Power Tilt (1 actuator). Only available with 2-post, flip back or pediatric armrests. Not available with 12”-14” width. Select a back cushion type in the subsequent section.
Account Number: ___________ Date: ________________ Marked for: _____________________________________
10. JOYSTICK MOUNTING BRACKETS continued
TRU-Balance 3 Seating section continued on following page.
TRU-Comfort 2 SPP, Matching Seat SizeReference part: XRF000116. MSRP: $400/$500
Stealth TRU-Comfort 2 SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover.Part series: ST-TC2SPPXXYY. HCPCS: E2607/E2608
Spectrum Gel SPP, Matching Seat SizeReference part: XRF000117. MSRP: $460/$530
Stealth Spectrum Gel SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner.Part series: ST-SPCGSPPXXYY. HCPCS: E2607/E2608
TRU-Comfort 2 or 4 Back Cushion, 22” Width .......................................................................................................................... $775HCPCS: E2621. Select size below. Height is overall. Part number is SET plus number following #. Sizes of 24" or greater may be TRU-Comfort 2 style back cushion until inventory is depleted.
Tilt:16"-17"H,Recline:19"-20"HPart: #124624
Tilt:18"-19"H,Recline:21"-22"HPart: #124625
Tilt:20"-21"H,Recline:23"-24"HPart: #124626
Tilt:22"-23"H,Recline:25"-26"HPart: #124627
Tilt:16"-17"H,Recline:19"-20"HPart: #124628
Tilt:18"-19"H,Recline:21"-22"HPart: #124629
Tilt:20"-21"H,Recline:23"-24"HPart: #124630
Tilt:22"-23"H,Recline:25"-26"HPart: #124631
Tilt:16"-17"H,Recline:19"-20"HPart: #130059
Tilt:18"-19"H,Recline:21"-22"HPart: #130060
Tilt:20"-21"H,Recline:23"-24"HPart: #130061
Tilt:22"-23"H,Recline:25"-26"HPart: #130062
22" Wide, 20"-24" Width Package:
24" Wide, 20"-24" Width Package:
24" Wide, 24"-28" Width Package:
1a. Sport Back/Omit/After-Market Interface
Page 6 of 16INFINFB4241/RevC/03AUG2021
10.14. Back Width PackageREQUIRED except when Omit Back Pan/Cushion is selected. Available with +/-4” of seat width.
Match Seat Width SelectionsPart: PTOINDV3468
16”W-20”W PackagePart: XRF000038
20”W-24”W PackagePart: XRF000040
24”W-28”W PackagePart: XRF000195
28”W-32”W PackagePart: XRF000196
10.12. 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 when Omit Back Pan/Cushion is selected. Reference colors shown in section 2.
10.13. Lateral Positioning WedgeOptional.
Lateral Positioning Wedge, pair ......................................................................................................................................... $30Part: SET123465Available with Sport and TRU-Comfort 2 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.
Red CorvettePart: XRF000019
Back in BlackPart: XRF000021
Night TrainPart: XRF000022
Grey StreetPart: XRF000023
Deep PurplePart: XRF000025
Pretty in PinkPart: XRF000027
Evolution OrangePart: XRF000028
Midnight BluePart: XRF000029
Electric BluePart: XRF000030
Green MachinePart: XRF000033
Tilt:16"-17"H,Recline:19"-20"HPart: #124633
Tilt:20"-21"H,Recline:23"-24"HPart: #124634
Tilt:20"-21"H,Recline:23"-24"HPart: #124647
Tilt:20"-21"H,Recline:23"-24"HPart: #124648
26" Wide, 24"-28" Width Package:
28" Wide, 24"-28" Width Package:
28" Wide, 28"-32" Width Package:
Account Number: ___________ Date: ________________ Marked for: _____________________________________
10. TRU-BALANCE 3 SEATING continuedTRU-Comfort 2 or 4 Back Cushion, 22” Width continued.
1e. Q-Back 2.0, AL Series, Extra Deep ContourNot available with Back Cane Option. Select a back type and the specific overall back height in subsequent section.
Deep Contour, 18"Wx19-20"H Tilt/22"-23" H Recline ............. $595Part: QB2AL18DS. HCPCS: E2620
Deep Contour, 18"Wx21-22"H Tilt/24"-25" H Recline ............. $595Part: QB2AL18DT. HCPCS: E2620
Deep Contour, 18"Wx23-24"H Tilt/26"-27" H Recline ............. $595Part: QB2AL18DX. HCPCS: E2620
Deep Contour, 18"Wx25-26"H Tilt/28"-29" H Recline ............. $595Part: QB2AL18DXX. HCPCS: E2620
Deep Contour, 20"Wx19-20"H Tilt/22"-23" H Recline ............. $595Part: QB2AL20DS. HCPCS: E2620
Deep Contour, 20"Wx21-22"H Tilt/24"-25" H Recline ............. $595Part: QB2AL20DT. HCPCS: E2620
Deep Contour, 20"Wx23-24"H Tilt/26"-27" H Recline ............. $595Part: QB2AL20DX. HCPCS: E2620
Deep Contour, 20"Wx25-26"H Tilt/28"-29" H Recline ............. $595Part: QB2AL20DXX. HCPCS: E2620
Extra Deep Contour, 18"Wx19-20"H Tilt/22"-23" H Recline ..... $595Part: QB2AL18ES. HCPCS: E2620
Extra Deep Contour, 18"Wx21-22"H Tilt/24"-25" H Recline ...... $595Part: QB2AL18ET. HCPCS: E2620
Extra Deep Contour, 18"Wx23-24"H Tilt/26"-27" H Recline ..... $595Part: QB2AL18EX. HCPCS: E2620
Extra Deep Contour, 18"Wx25-26"H Tilt/28"-29" H Recline ..... $595Part: QB2AL18EXX. HCPCS: E2620
Extra Deep Contour, 20"Wx19-20"H Tilt/22"-23" H Recline ..... $595Part: QB2AL20ES. HCPCS: E2620
Extra Deep Contour, 20"Wx21-22"H Tilt/24"-25" H Recline ..... $595Part: QB2AL20ET. HCPCS: E2620
Extra Deep Contour, 20"Wx23-24"H Tilt/26"-27" H Recline ..... $595Part: QB2AL20EX. HCPCS: E2620
Extra Deep Contour, 20"Wx25-26"H Tilt/28"-29" H Recline ..... $595Part: QB2AL20EXX. HCPCS: E2620
1d. Q-Back 2.0, AL Series, Deep ContourNot available with Back Cane Option. Select a back type and the specific overall back height in subsequent section.
1c. Q-Back 2.0, AL Series, Active ContourNot available with Back Cane Option. Select a back type and the specific overall back height in subsequent section.
Active Contour, 18"Wx19-20"H Tilt/22"-23" H Recline ............ $525Part: QB2AL18AS. HCPCS: E2613
Active Contour, 18"Wx21-22"H Tilt/24"-25" H Recline ............ $525Part: QB2AL18AT. HCPCS: E2613
Active Contour, 18"Wx23-24"H Tilt/26"-27" H Recline ............ $525Part: QB2AL18AX. HCPCS: E2613
Active Contour, 18"Wx25-26"H Tilt/28"-29" H Recline ............ $525Part: QB2AL18AXX. HCPCS: E2613
Active Contour, 20"Wx19-20"H Tilt/22"-23" H Recline ............ $525Part: QB2AL20AS. HCPCS: E2613
Active Contour, 20"Wx21-22"H Tilt/24"-25" H Recline ............ $525Part: QB2AL20AT. HCPCS: E2613
Active Contour, 20"Wx23-24"H Tilt/26"-27" H Recline............ $525Part: QB2AL20AX. HCPCS: E2613
Active Contour, 20"Wx25-26"H Tilt/28"-29" H Recline............ $525Part: QB2AL20AXX. HCPCS: E2613
TRU-Balance 3 Seating section continued on following page.
Page 7 of 16INFINFB4241/RevC/03AUG2021
10.17. Power Tilt Privacy FlapOptional. A privacy flap is standard with power recline systems. This selection is to add a flap for power tilt only systems.
Privacy Flap, 9.75” .........................................................$45Part: DWR1044E456B
Privacy Flap, 12.75” .......................................................$45Part: DWR1044E456A
10.15. Back WidthREQUIRED except when Omit Back Pan/Cushion is selected. Part number is PTOINDV plus number following # below. Available with +/-4” of seat width.
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)
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
10.16. Overall Back 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 back availability chart for stock order back size ranges.
16” Overall HeightPart: SETHGHT1029
17” Overall HeightPart: SETHGHT1030
18” Overall HeightPart: SETHGHT1031
19” Overall HeightPart: SETHGHT1032
20” Overall HeightPart: SETHGHT1033
21” Overall HeightPart: SETHGHT1034
22” Overall HeightPart: SETHGHT1035
23” Overall HeightPart: SETHGHT1036
24” Overall HeightPart: SETHGHT1037
25” Overall HeightPart: SETHGHT1038
26” Overall HeightPart: SETHGHT1039
27” Overall HeightPart: SETHGHT1040
28” Overall HeightPart: SETHGHT1041
10. TRU-BALANCE 3 SEATING continued
Account Number: ___________ Date: ________________ Marked for: _____________________________________
11.3. Armrest SizeREQUIRED with armrest selection above. Select a left (L) and right (R) armrest size. This also affects armpad selection.
10” LengthL part: XRF000057. R part: XRF000123
14” LengthL part: XRF000058. R part: XRF000124
17” LengthL part: XRF000059. R part: XRF000125Only available with Flip-Back Armrests and straight arm pads.
11.2. Armrest HeightSet left and right armrest height. Note the available height range in the option description.1. Left Armrest Height
2. Right Armrest Height
11.1b. Height Adjustable, Removable, Heavy Duty ArmrestsSelect a type of HD removable armrests and the set height in the following section. Only one height package is selectable as a normal configuration. Payer coding, coverage, and bundling guidelines may apply.
8”-12”H, Single Post, Height Adjustable, Removable, .........$75 ea.Heavy Duty (Sold in pairs)Part: XRF000055. HCPCS w/ Static Seat: E0973
10”-14”H, Single Post, Height Adjustable, Removable,........$75 ea.Heavy Duty (Sold in pairs)Part: XRF000056. HCPCS w/ Static Seat: E0973
8” HPTOINDV3535
9” HPTOINDV3536
10” HPTOINDV3537
11” HPTOINDV3538
12” HPTOINDV3539
13” HPTOINDV3540
14” HPTOINDV3541
15” HPTOINDV3542
16” HPTOINDV3543
8” HPTOINDV3450
9” HPTOINDV3451
10” HPTOINDV3452
11” HPTOINDV3453
12” HPTOINDV3454
13” HPTOINDV3455
14” HPTOINDV3456
15” HPTOINDV3457
16” HPTOINDV3458
Flip-Back, 22"-26"Widths, 8"-16"H Armrests .............. StandardLeft part: ARM2004694. Right part: ARM2004693
Flip-Back, 26"-32"Widths, 8"-16"H Armrests .............. StandardLeft part: ARM2004696. Right part: ARM2004695
11.1a. Flip-Back, 8"-16" H ArmrestsChoose a left and right armrest and set height in the following section. Flip-back armrests include an armrest downpost on the Q6 Edge HD. Not available with waterfall armpads. Not available with Back Cane Option.
11. 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.
Page 8 of 16INFINFB4241/RevC/03AUG2021
12.1a. Omit ArmpadSelect one below if aftermarket armpads or handpads are required. See Positioning Components Order Form.
Account Number: ___________ Date: ________________ Marked for: _____________________________________
12.1c. Gel ArmpadsSold only in pairs. Armpads are 3” wide. Manufacturer part number for full length is 314G and desk length is 310G.
12. TRU-BALANCE 3 ARMPADSREQUIRED with armrest selection above except for Drop-In, T-Arm. Please note that waterfall and gel armpads may cause interference with the seat back.
12.1b. Foam Armpads
b. Falcon Gel Armpads for Tube Style Armrests
No Armpad Selection .............................................. No ChargePart: XRF000060Not available with Flip-back, 8"-16" H armrests.
Interface for Aftermarket Pad .................................. No ChargePart: XRF000308Only available with Flip-back, 8"-16" armrests.
Straight, Armpad ................................................ StandardLeft part: XRF000061. Right part: XRF000126
Waterfall, Armpad ............................................ No ChargeLeft part: XRF000062. Right part: XRF000127Not available with Flip-back, 8"-16" armrests.
13. TRU-BALANCE 3 JOYSTICK BRACKET RECEIVERREQUIRED.
Standard Fixed Receiver ........................................... StandardPart: XRF000063
Stealth Height Adjustable Receiver ................................... $214Part: XRF000064. HCPCS: K0108
Falcon Gel, Full Length Left and Right ............................... $185Part: ARM1806807
Falcon Gel, Full Length Left, Desk Length Right ............... $162.50Part: ARM1806813
Falcon Gel, Desk Length Left, Full Length Right ............... $162.50Part: ARM1806810
Falcon Gel, Desk Length Left and Right ............................. $140Part: ARM1806806
a. Falcon Gel Armpads for Flip-Back Armrests
Falcon Gel, Full Length Left and Right ........................... $296.40Part: ARM136438
Falcon Gel, Full Length Left, Desk Length Right ............... $274.22Part: ARM136442
Falcon Gel, Desk Length Left, Full Length Right ............... $274.22Part: ARM136439
Falcon Gel, Desk Length Left and Right ......................... $252.40Part: ARM136437
15.1b. Optional Lap Belts
15.1a. Standard Lap Belts
15. LAP BELTSREQUIRED. Select a lap belt below.
38” Lap BeltPart: ACCBELT1006
50” Lap BeltPart: ACCBELT1000
60” Lap BeltPart: ACCBELT1002
70” Lap BeltPart: ACCBELT1003
80” Lap BeltPart: ACCBELT1004
90” Lap BeltPart: ACCBELT1001
Stealth Retractable Lap Belt (IFRB5350) ..............................$175Part: ST-IFRB5350
Stealth Positioning, 60” Single Pull, Push Button, Medium........$86(7.5”) Padded, 1.5” Belt (IFPB5213)Part: ST-IFPB5213-Q
Stealth Positioning, 60” Single Pull, Push Button, Large ..........$86Padded (9.5”), 2” Belt (IFPB5314)Part: ST-IFPB5314-Q
Stealth Positioning, 60” Single Pull, Push Button, Extra Large ...$86Padded (11.5”), 2” Belt (IFPB5315)Part: ST-IFPB5315-Q
Multi-Axis Removable Headrest Bracket (HMO475P) ...........................................................................................................$160.50Part: HDWASMB1084. HCPCS: E1028
Stealth 8” Comfort Plus (CP450) ....................................$151.94Part: POS148484. HCPCS: E0955
Stealth 10” Comfort Plus (CP250) ..................................$151.94Part: SETHEAD1057. HCPCS: E0955
Stealth 14” Comfort Plus (CP150) ..................................$151.94Part: INDPART2327. HCPCS: E0955
Pediatric Comfort Plus (6”Wx4.5”H) (CPN350) ..................$151.94Part: SETHEAD1069. HCPCS: E0955
1. Headrest Pads
2. Headrest Brackets
14.1b. Headrests, Comfort Plus
1. Headrest Pads
2. Headrest Brackets
14.1a. Headrests, Comfort Plus with Cool Core
Stealth 8” Comfort Plus, Cool Core (CP08CCFPM) ..................$167Part: ST-CP08CCFPM-Q. HCPCS: E0955
Stealth 10” Comfort Plus, Cool Core (CP10CCFPM) .................$167Part: ST-CP10CCFPM-Q. HCPCS: E0955
Stealth 14” Comfort Plus, Cool Core (CP14CCFPM) .................$167Part: ST-CP14CCFPM-Q. HCPCS: E0955
Stealth 6", Comfort Plus, Cool Core (CP06CCFPM) ..................$167Part: ST-CP06CCFPM-Q. HCPCS: E0955
Comfort Plus Headrest Mounting Bracket, UniLink ................................................................................................................ $294Part: ST-UHB2D33200-Q. HCPCS: E1028
14. TRU-BALANCE 3 HEADRESTSOptional. Select a headrest pad and bracket.
Page 9 of 16INFINFB4241/RevC/03AUG2021
4. Modular Footplate Extension ComponentsOptional. Assembly required. May require seating configuration adjustments to avoid front caster interference.
Width Extension for 8”D Footplates ...................................$65Part: RIG152517
Width Extension for 11”D Footplates ..................................$65Part: RIG152518
2” Bell-Shaped Length Extension .......................................$65Part: RIG152519Not compatible with width extensions. Can be used with 6” outside edge with 11” footplates.
4” Outside Edge (pair) .....................................................$65Part: RIG152510Only available with 6”D footplates and 8”D footplate extension.
6” Outside Edge (pair) .....................................................$65Part: RIG152516Available with 8”D and 11”D footplates and 11”D footplate 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 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
3a. Center Mount Calf PadsCalf pads are standard with a power articulating foot platform.
3b. Center Mount Calf PanelCalf pads are standard with a power articulating foot platform.
Small Calf Pads, AFP Only, 6”Wx6”H (pair) .................... StandardPart: RIGASMB7120018
Small Calf Pads, Manually Adjustable Center Mount Only, ...... $1506”Wx6”H (pair)Part: XRF000156
Large Calf Pads, AFP Only, 8” taper to 6"Wx8”H (pair) ..... StandardPart: RIGASMB7120019
Large Calf Pads, Manually Adjustable Center Mount Only, ..... $1508” taper to 6"Wx8”H (pair)Part: XRF000157
Small Calf Panel for AFP, 18”Wx8”H ...................................$175Part: FRMASMB7110007
Large Calf Panel for AFP, 24”Wx8”H ................................. $225Part: RIG123824Only available on widths of 20” or greater.
Small Calf Panel for Manually Adjustable, 18”Wx8”H .............$175Part: FRMASMB7110012
Large Calf Panel for Manually Adjustable, 24”Wx8”H ............ $225Part: RIG123825Only available on widths of 20” or greater.
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Legrests section continued on following page.
Base Mounted Foot Platform ...................................... StandardPart: FRMASMB16077
Base Mounted, Bell Shaped Foot Platform ................... No ChargePart: RIGASMB7120041
Omit Base Mounted Foot Platform ............................. No ChargePart: PTOINDV3674
17.1a. Center Mount Foot PlatformIf power articulating foot platform is selected, be sure power legrest control has been selected in earlier section. Select legrest length in following section.
2. Lower Extension and Angle Adjustable Footplates
1. Foot Platform AssemblyPower Articulating Foot Platform .................. $2,995Part: PTOINDV3754. HCPCS: E1012+K0040
Manually Adjustable Center Mount ...................$250Foot Platformpart: XRF000155. HCPCS: K0040 Power Articulating
Foot Platform
10"-16" Extension, 5"x6" FootplatesPart: RIG150206
10"-16" Extension, 5"x8" FootplatesPart: RIG150203
10"-16" Extension, 5"x11" FootplatesPart: RIG150212
13"-19" Extension, 5"x6" FootplatesPart: RIG151505
13"-19" Extension, 5"x8" FootplatesPart: RIG151506
13"-19" Extension, 5"x11" FootplatesPart: RIG151508
16. BASE MOUNTED FOOT PLATFORMREQUIRED. Select a foot platform option. A base mounted foot platform is not available with center mount foot platforms. May interfere with seat mounted legrests.
17. LEGRESTSOptional. 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.
Page 10 of 16INFINFB4241/RevC/03AUG2021
1. Heavy Duty, Elevating Legrest Selection
2. Lower Extension
3. Reinforced Footplates(s)
4. Angle Adjustable Footplates(s) with Heel Loops
17.1c. Heavy Duty, Elevating LegrestsSelect a configuration, a legrest, extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.
Heavy Duty, Elevating Legrest(s) with Calf Pad(s) ............................................................................................... $162.50 ea.Pair part: FRMASMB6702. Left: FRMASMB8444. Right: FRMASMB8445. HCPCS: E0990
7.25”Wx6”D Extruded Footplate ........................ StandardPart pair: FRMASMB4748. Left: RIG138055. Right: RIG138056
8.5”Wx6”D Extruded Footplate ......................... StandardPart pair: FRMASMB4747. Left: RIG138060. Right: RIG138062
6”Wx8”D .......................................................$85 ea.Pair part: FRMASMB4738. Left: RIG137793. Right: RIG137795.HCPCS: K0040+E0951
6”Wx11”D ......................................................$85 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797.HCPCS: K0040+E0951
8”Wx11”D ......................................................$85 ea.Pair part: FRMASMB4744. Left: RIG137798. Right: RIG137799.HCPCS: K0040+E0951May cause interference with seat widths less than 20"
11”-14” LengthPart: FRMASMB4755. Left: RIG138026. Right: RIG138030For reinforced footplates only.
8.5"-12" HD Drop-Ins/12.5"-16.5" ELR, Ext LengthPair part: XRF000101. Left: XRF000102. Right: XRF000103.For angle adjustable footplates only.
14”-17” LengthPart: FRMASMB4756. Left: RIG138033. Right: RIG138035For reinforced footplates only.
13"-18" HD Drop-Ins/15.5"-19.5" ELR, Ext Length Pair part: XRF000104. Left: XRF000105. Right: XRF000106For angle adjustable footplates only.
17.1b. Heavy Duty, Drop-In, Swing-Away LegrestsSelect a configuration, a legrest, extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.
70° HD Drop-in for 8.5"-12" Lower Extension ..... No ChargePair part: FRMASMB4762. Left: RIG137706. Right: RIG137707
70° HD Drop-in 13"-18" or 16"-21" Lower ............ No Charge Extension
Pair part: FRMASMB4853. Left: RIG137708. Right: RIG137709
6”Wx8”D1 ......................................................$85 ea.Pair part: FRMASMB4738. Left: RIG137793. Right: RIG137795.HCPCS: K0040+E0951
6”Wx11”D1 .....................................................$85 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797.HCPCS: K0040+E0951May cause interference on seat widths less than 18".
8”Wx11”D2 .....................................................$85 ea.Pair part: FRMASMB4744. Left: RIG137798. Right: RIG137799.HCPCS: K0040+E0951May cause interference on seat widths less than 20".
1. Drop-In Legrest Selection
3. Angle Adjustable Footplate(s) with Heel Loops
8.5"-12" HD Drop-Ins/12.5"-16.5" ELR, Ext LengthPair part: XRF000101. Left: XRF000102. Right: XRF000103.
13"-18" HD Drop-Ins/15.5"-19.5" ELR, Ext Length Pair part: XRF000104. Left: XRF000105. Right: XRF000106
16"-21" HD Drop-Ins/18.5"-22.5" ELR, Ext Length Pair part: FRMASMB4754. L: FRMASMB4725. R: FRMASMB5393
2. Lower Extension
Small Reversed Dartex Calf Pad Cover (pair) ....................... $200Part: RIG133717
Large Reversed Dartex Calf Pad Cover (pair) ....................... $200Part: RIG133719
Small Reversed Dartex Panel Cover (pair) ........................... $200Part: RIG134673
Large Reversed Dartex Panel Cover (pair) .......................... $200Part: RIG134744
Footplate Connector ....................................................... $15Part: RIGASMB7120023
5. Center Mount Additional Accessories
5"x8" Tapered Gel Footplate Covers .................................. $205Part: ST-FPG5008T-Q. HCPCS: K0108
5"x11" Tapered Gel Footplate Covers ................................. $225Part: ST-FPG5011T-Q. HCPCS: K0108
5"x8" Tapered Gel Footplate Covers for Width Extension ....... $225Part: ST-FPG6508T-Q. HCPCS: K0108
5"x11" Tapered Gel Footplate Cover for Width Extension ....... $250Part: ST-FPG7011T-Q. HCPCS: K0108
6. Stealth Gel Footplate Covers
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Legrests section continued on following page.
17. LEGRESTS continued
Page 11 of 16INFINFB4241/RevC/03AUG2021
18.2. 4-Function Push Button/iAccess MountREQUIRED with 4-function push button and iAccess options. Under arm mount is not available with TRU-Balance 3 HD armrests.
Joystick Mount ..................................................... No ChargePart: MEC1907500
Under Arm Mount, Flip-Back Armrest ......................... No ChargePart: MEC1906531
Under Arm Mount, Tube Style Armrest ....................... No ChargePart: MEC1906530
Attendant Mount ............................................................$25Part: MEC1906564
Under Arm Mount, Flip-Back Armrest, plus iAccess Guard ........$25Part: MEC2001400
Under Arm Mount, Tube Style Armrest, plus iAccess Guard ......$25Part: MEC2001401
1. Under Arm Mount Side SelectionLeft Side Under Arm MountPart: PTOINDV3678
Right Side Under Arm MountPart: PTOINDV3679
18.1d. Q-Logic 3 Controls with iAccess Switch ControliAccess control is not available with combined or independent power legrests.
Single Actuator Control, Through Flat Button ....................$2,425iAccess and Q-Logic 3 Controller and Interface (AM1)Part: XRF000070. HCPCS: E2310
Single Actuator Control, Through Flat Button ....................$3,295iAccess and Q-Logic 3 Controller and Interface (AAM)Part: XRF000071. HCPCS: E2310
Multiple Actuator Control Through Flat Button ..................$3,295iAccess and Q-Logic 3 Controller and Interface (AAM)Part: XRF000072. HCPCS: E2311
Single Actuator Control, Through Toggle Button ................$2,425iAccess and Q-Logic 3 Controller and Interface (AM1)Part: XRF000073. HCPCS: E2310
Single Actuator Control, Through Toggle Button ................$3,295iAccess and Q-Logic 3 Controller and Interface (AAM)Part: XRF000074. HCPCS: E2310
Multiple Actuator Control Through Toggle Button ...............$3,295iAccess and Q-Logic 3 Controller and Interface (AAM)Part: XRF000075. HCPCS: E2311
Left Side TogglePart: PTOINDV1839
Right Side TogglePart: PTOINDV1838
1. Toggle Mount Side Selection
17.2. Set Legrest Extension LengthREQUIRED with matching left and right legrest configuration. Part number is PTOINDV plus number following # below. 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.
8.5” L(#3473)
9” L(#3474)
9.5” L(#3475)
10” L(#3476)
10.5” L(#3477)
11” L(#3478)
11.5” L(#3479)
12” L(#3480)
12.5” L(#3481)
13” L(#3482)
13.5” L(#3483)
14” L(#3484)
14.5” L(#3485)
15” L(#3486)
15.5” L(#3487)
16” L(#3488)
16.5” L(#3489)
17” L(#3490)
17.5” L(#3491)
18” L(#3492)
Account Number: ___________ Date: ________________ Marked for: _____________________________________
17. LEGRESTS continued
18.1a. Tilt Only through Toggle
18. TRU-BALANCE 3 POWER POSITIONING ELECTRONICSREQUIRED with power seating or legrest options.
Single Actuator Control, Power Tilt Only, Through Toggle (NE 4-Key Joystick Only) ................................................................No ChargePart: ELE1905907Select toggle side. May require extended lead time when selected with Fender Lights.
18.1c. Q-Logic 3 Controls through Joystick
18.1b. NE+ 6 Key Controls through Joystick
Switch Controls
4 Way Toggle
4 Way ButtonToggle
4 FunctionPush Button
iAccessFlat Button
iAccessToggle Button
Single Actuator Control Through NE+ Joystick .. $2,060Part: XRF000065. HCPCS: E2310
Two Actuator Control Through NE+ Joystick .... $2,895Part: XRF000066. HCPCS: E2311
Single Actuator Through Q-Logic 3 ................ $2,060Controller and Interface (AM1)Part: XRF000067. HCPCS: E2310
Single Actuator Through Q-Logic 3 ................ $2,895Controller and Interface (AAM)Part: XRF000068. HCPCS: E2310
Multiple Actuator Through Q-Logic 3.............. $2,895Controller and Interface (AAM)Part: XRF000069. HCPCS: E2311
4-Function Push ButtonPart: CTL123218See following section for switch mounting.
4-Way TogglePart: ELEASMB5925
4-Way Button TogglePart: ELEASMB5926
1. Optional Switch ControlNot available with AM1 electronics. 4-Way switches will be mounted to same side of joystick.
19. 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 ........................................................ $500Part: XRF000078. HCPCS: E2331Select this option if no charge option criteria is not met.
Attendant Control with Tilt, Recline, Alternative .......... No ChargeControls and Q-Logic Display or SCIM ModulePart: XRF000079
Page 12 of 16INFINFB4241/RevC/03AUG2021
Account Number: ___________ Date: ________________ Marked for: _____________________________________
20 FULL LIGHT PACKAGEOptional. Requires NE+ 8 Key or Q-Logic 3 Joystick for Full Light Package.
Seat Mounted, LED, Full Light Package .............................................................................................$995Part: XRF000130
Seat Mounted LEDLights (One Shown)
21. ACCESSORIESOptional. Multiple accessories can be mounted along the various tracks but some interference may occur. Accessories may need to be mounted by the provider.
TRU-Balance 3Accessories
TRU-Balance 3 Cane/Crutch Holder ..................$100Part: ACC152515. HCPCS: E2207
Quantum Backpack ....................................... $160Part: ACC1905853
Grip Lap Board (20005)............................... $38.95Part: ACC152992
Grip Drink Holder (20085) ........................... $15.50Part: ACC152993
TRU-Balance 3 Hydration System (B) .................$225Part: ACC125010
TRU-Balance 3 Transfer Handle (D) .............. $100 ea.Part: MEC1809930. HCPCS: E0705Not available with Heavy Duty armrests.
TRU-Balance 3 Cup Holder .......................No ChargePart: ACC125003For use with TRU-Balance 3 (track style) armrests.
Cup Holder (Tube-style Armrest) ...............No ChargePart: ACCASMB2634For use with tube-style armrests.
TRU-Balance 3 Personal Item Hook .................... $65Part: ACC125008Not available with back cane option.
TRU-Balance 3 Reflector Kit ............................. $50Part: ACC124670
TRU-Balance 3 Backpack Holder (Pair) (A) ........... $65Part: ACC147774Not available with back cane option.
TRU-Balance 3 Front Mounted .......................... $65Cell Phone/ Media Holder, X-Grip (E)Part: ACC155835Not available with Heavy Duty armrests.
TRU-Balance 3 Rear View Mirror ....................... $65Part: ACC155833Not available with Heavy Duty armrests.
TRU-Balance 3 Oxygen Holder .........................$200Part: ACC125006. HCPCS: E2208Includes accessory bar, a credit will be applied PTOIN-DV3769.
TRU-Balance 3 Clothing Guard (Pair) .................$225Part: ACC125007Not available with Heavy Duty armrests.
TRU-Balance 3 Glove Box (C) ........................... $150Part: ACC125011
Stealth Large Tablet Holder ............................$375Part: ACC141818Not available with Heavy Duty armrests.
Trilogy Vent Tray ..........................................$400Part: ACC136791. HCPCS: E1029Includes accessory bar, a credit will be applied PTOIN-DV3769. Contact custom for models other than 100 and 200.
Compact Vent Tray .....................................$1,395Part: ACC133889. HCPCS: E1029
Push Handles (pair) ....................................... $185Part: ACC2005027Not available with oxygen holder, back cane option, or vent tray. Required with attendant manual recline.
Accessory Bar .............................................. $125Part: ACC1909634Horizontal rail attached to rear of seat. Standard with the Trilogy vent tray and oxygen holder. Not available with back cane option.
Large, Black, Weather Cover ...........................$202Part: ACCCOVR1021
Q-Logic EX/NE Programmer ............................$545Part: ELEASMB6976
Privacy Bag ...............................................$39.95Part: ACC1907570
VOCSN Vent Tray for Power Tilt, Seat Mount .......$895Part: ACC2000162. HCPCS: E1029
VOCSN Vent Tray for Power Lift, Seat Mount .......$895Part: ACC2000159. HCPCS: E1029
VOCSN Vent Tray for Accessory Bar Mount ..........$895Part: ACC2000166. HCPCS: E1029Includes accessory bar, a credit will be applied PTOIN-DV3769.
Flip-Back Armrest, Side Track Accessory Bracket ...$10Part: MEC1809178Only available with flip-back, 8"-16" H armrests. This adds a 47mm channel to the side of the armrest to allow mounting of accessories with t-nuts.
Personal Item Pouch ...................................$79.95Part: ACC2101017
Compact and Trilogy
Page 13 of 16INFINFB4241/RevC/03AUG2021
2. Pelvic/Thigh Guide Adapter2” Height Adapter Plate (LHW-122) .................................$26.25Part: INDPART2821. HCPCS: K0108Height adapter is needed with TRU-Comfort seat cushions. Not avail-able with the flip down bracket.
2 1/4” Adapter Plate (LHW-129) .....................................$53.50Part: POS140430. HCPCS: K0108Only available with the flip down full surface bracket.
1. Pelvic/Thigh Guide Bracket
23.3. Stealth Pelvic/Thigh GuidesPelvic/thigh guides may interfere with the joystick receiver block and down posts. Please provide quantity next to check box.
Flip Down Bracket (TWBTLADD-HW) ................... $236.25 ea.Part: INDPART2804. HCPCS: E1028
Removable Bracket (LP430) ............................... $262.50 ea.Part: INDPART2805. HCPCS: E1028
Removable Bracket with 1” Offset .......................... $400 ea. (LP430 & LHW-121)
Part: INDPART2854. HCPCS: E1028
Flip Down with LEFT Full Surface Contact ................. $236.25 ea.Feature (TWBADD-L & LPHW407)Part: POS140428. HCPCS: E1028
Flip Down with RIGHT Full Surface Contact ................ $236.25 ea.Feature (TWBADD-R & LPHW407)Part: POS140429. HCPCS: E1028
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Military Patches
22. BRANCH PATCHESOptional.
Air Force Patch .................. $20Part: ACC140240
Army Patch ....................... $20Part: ACC140241
Coast Guard Patch .............. $20Part: ACC140239
Marines Patch .................... $20Part: ACC140243
Navy Patch ....................... $20Part: ACC140244
Purple Heart Patch ............. $20Part: ACC140238
Positioning components section continued on following page.
1. Thoracic Lateral Bracket
2. Thoracic Lateral Pads
3. Thoracic Lateral Installation
Swing-away, Rail Mounts, pair (TWBTLTC) ...................................................................................................................... $472.50Part: INDPART2677. HCPCS: E1028
Curved Pads, 3”x5”, pair (TWBL-3X5) ................................ $210Part: INDPART2663. HCPCS: E0956
Curved Pads, 4”x6”, pair (TWBL-4X6) ................................ $210Part: INDPART2664. HCPCS: E0956
Flat Pads, 3”x5”, pair (TWBLP3X5) ................................... $210Part: INDPART2676. HCPCS: E0956
Flat Pads, 4”x6”, pair (TWBLP4X6) ................................... $210Part: INDPART2675. HCPCS: E0956
23.1. Stealth Thoracic LateralsSwing-away laterals may interfere with TRU-Balance 3 armrests and 2-post, flip up armrests. These laterals are not available with the back cane option.
23. POSITIONING COMPONENTSOptional. More options are available on the Positioning Components Order Form.
Install LateralsPart: PTOINDV3499
Do Not InstallPart: PTOINDV3500
4. UniLink Pelvic/Thigh Guide Installation
1. UniLink Pelvic/Thigh Hardware
2. UniLink Pelvic/Thigh Pads
3. UniLink Pelvic/Thigh Additional Links
23.2. Stealth UniLink Pelvic/Thigh Guide
UniLink, 5" Height Adjustable & Removable Hardware ... $245 ea.Part: ST-UTTP5-Q. HCPCS: K01028
UniLink, 7" Height Adjustable & Removable Hardware... $255 ea.Part: ST-UTTP7-Q. HCPCS: K01028
UniLink Pad & Hardware
Install on LeftPart: PTOINDV3585
Install on RightPart: PTOINDV3586
Do Not InstallPart: PTOINDV3719
UniLink, 4" x 4" Pad ..............................$95 ea.Part: ST-UTP544056100-Q. HCPCS: E956
UniLink, 4" x 8" Pad ............................. $105 ea.Part: ST-UTP548056100-Q. HCPCS: E956
UniLink, 4" x 12" Pad ........................... $125 ea.Part: ST-UTP54D056100-Q. HCPCS: E956
UniLink, 1.5" Link ............................... $75 ea.Part: ST-UIL00I150A000-Q
UniLink, 2" Link ................................... $75 ea.Part: ST-UIL00I200A000-Q
Page 14 of 16INFINFB4241/RevC/03AUG2021
23.9. Stealth Padded Shoe HolderStealth Small Padded Shoe Holder, 3.75"Wx6.25"D ............... $266(SPLE111) (pair)Part: INDPART2783. HCPCS: E0951+E0952
Stealth Medium Padded Shoe Holder, 4"Wx8.25"D ................ $266(SPLE112) (pair)Part: INDPART2784. HCPCS: E0951+E0952
Stealth X-Large Padded Shoe Holder, 5"Wx10.75"D ............... $266(SPLE114) (pair)Part: INDPART2785. HCPCS: E0951+E0952
23.8. Stealth Foot BoxesStealth Small Foot Boxes, 5"Wx8"Dx7"H ......................... $498.75(SPLE107) (pair)Part: INDPART2786. HCPCS: E0954
Stealth Medium Foot Boxes, 6"Wx10"Dx9"H .................... $498.75(SPLE108) (pair)Part: INDPART2787. HCPCS: E0954
Stealth Large Foot Boxes, 7"Wx12"Dx11"H ...................... $498.75(SPLE109) (pair)Part: INDPART2788. HCPCS: E0954
23.5. Stealth Positioning Chest Straps
Chest Strap
23.4. Stealth Positioning Chest Harness
Contoured and ClassicChest Harness
Upper Classic, Medium (IFPS1103) ............... $142 ea.Part: ST-IFPS1103-Q. HCPCS: E0960
Upper Classic, Large (IFPS1104) .................. $142 ea.Part: ST-IFPS1104-Q. HCPCS: E0960
Upper Contour, Medium (IFPS2103) .............. $142 ea.Part: ST-IFPS2103-Q. HCPCS: E0960
Upper Contour, Large (IFPS2104) ................ $142 ea.Part: ST-IFPS2104-Q. HCPCS: E0960
Chest Strap, Medium w/ Belt Anchor, (IFCS4113) ..$90 ea.Part: ST-IFCS4113-Q. HCPCS: E0960
Chest Strap, Large w/ Belt Anchor, (IFCS4114) ....$90 ea.Part: ST-IFCS4114-Q. HCPCS: E0960
23.6. Stealth Swing-Away Headrest MountsThese swing-away headrest mounts are only available with the Stealth Comfort Series headrests.
Left and Right FacialLateral with Pads
1. Facial Lateral HardwareFacial Lateral for Comfort Series .............$294.25 ea.Right Side (CPS9-R-HW)Part: INDPART2647. HCPCS: E1028
Facial Lateral for Comfort Series .............$294.25 ea.Left Side (CPS9-L-HW)Part: INDPART2648. HCPCS: E1028
Facial Laterals for Comfort Series ........... $347.75 ea.Left and Right Side (CPS9-B-HW)Part: INDPART2649. HCPCS: E1028
Headrest Accessories
2. Facial Lateral Pads and AccessoriesEgg Switch Mount (ESM) (A) ................ $52.50 ea.Part: INDPART2815
Figure 8 Bracket with 13" Rod ............ $267.50 ea. and Egg Switch Mount (B)
Part: ST-F8675-13-Q
Facial Pad, 4"x2" (900-Q)................... $53.50 ea.Part: ST-900-Q. HCPCS: K0108
Facial Pad, 6"x2" (920-Q) ................... $53.50 ea.Part: ST-920-Q. HCPCS: K0108
Swing-Away Joystick Mount, 18" Rod (C) .... $250 ea.Part: ST-SUS18-Q Allows mounting of facial pads and attaches to the headrest
3. Pelvic/Thigh Guide Pad
4. Pelvic/Thigh Guide InstallationInstall on LeftPart: PTOINDV3585
Install on RightPart: PTOINDV3586
Do Not InstallPart: PTOINDV3719
Short Pad, 4”x4” (TWBADD-4X4) ..............................$75 ea.Part: INDPART2801. HCPCS: E0953/E0956
Medium Pad, 4”x8” (TWBADD-4X8) ...........................$75 ea.Part: INDPART2802. HCPCS: E0953/E0956
Long Pad, 4”x12” (TWBADD-4X12) ............................$75 ea.Part: INDPART2803. HCPCS: E0953/E0956
Account Number: ___________ Date: ________________ Marked for: _____________________________________
23. POSITIONING COMPONENTS continued
2. Elbow Support Pad
1. Elbow Support Bracket23.7. Stealth Elbow Support
Left,Swing-Away, Elbow Support ........ $183.75 ea. Bracket Tube Style Arms (ARMS-ES-L)
Part: POS124064. HCPCS: E1028
Left, Fixed Elbow Support Bracket ...... $183.75 ea. TRU-Balance 3 Arms (ARMS-ESFTB3-L)
Part: POS133465
Right, Swing-Away, Elbow Support ...... $183.75 ea. Bracket Tube Style Arms (ARMS-ES-R)
Part: POS124066. HCPCS: E1028
Right, Fixed Elbow Support Bracket .... $183.75 ea. TRU-Balance 3 Arms (ARMS-ESFTB3-R)
Part: POS133466
3"Wx3"H Elbow Pad (ARMS-ES-3X3) ...... $52.50 ea.Part: POS124065. HCPCS: K0108
4"Wx4"H Elbow Pad (ARMS-ES-4X4) ...... $52.50 ea.Part: POS124067. HCPCS: K0108
Elbow Supports
Page 15 of 16INFINFB4241/RevC/03AUG2021
Egg Switch
Red Egg Switch (ESRED) .......................... $80.85Part: SWTMCRO1077
Blue Egg Switch (ESBLU) ......................... $80.85Part: SWTMCRO1079
Black Egg Switch (ESBLK) ........................ $80.85Part: SWTMCRO1081
Green Egg Switch (ESGRN) ...................... $80.85Part: SWTMCRO1078
Yellow Egg Switch (ESYEL) ...................... $80.85Part: SWTMCRO1080
24.6. Egg Switches
Sip & Puff Straws, 12 pack (SP625-S12).............$32.10Part: ST-SP625-S12-Q
Sip & Puff Bus Cable ......................................$425Part: DWR1111H046
3. Sip & Puff Accessories
Stealth Sip and Puff for Comfort Series, .........$294.25Left Mount (SP625-CL)Part: ST-SP625-CL-Q. HCPCS: E2326 Includes straw and mounting hardware. Use with Stealth Comfort Plus headrests.
Stealth Sip and Puff for Comfort Series, .........$294.25Right Mount (SP622-CR)Part: ST-SP625-CR-Q. HCPCS: E2326Includes straw and mounting hardware. Use with Stealth Comfort Plus headrests.
Stealth Sip and Puff for Stealth i-Drive, .........$294.25Head Array (SP625-U)Part: ST-SP625-U-Q. HCPCS: E2326 Includes straw and mounting hardware. Use with Stealth i-Drive Head Arrays.
Stealth Sip & Puff
2. Sip and Puff Straw and MountThe straw and mount do not include electrical components to operate the Sip&Puff with a head array. This component requires the selection of a Q-Logic Sip&Puff module or additional module from Stealth Products for operation.
Sip and Puff Module for Q-Logic 3 ..................................................................................................$1,895Part: CTL168056. HCPCS: E2325 Includes module and mounting hardware. Sip & Puff Module
24.5. Sip and Puff Drive1. Sip and Puff Module
24.3. Q-Logic 3 SAJQ-Logic 3 EX SAJ .........................................................................................................................$700Part: CTL143980Must be used in conjunction with Enhanced Display or Q-Logic 3 Joystick.
EX SAJ
24.2. SCIM ModuleOptional.
SCIM Module Kit for Q-Logic 3......................................................................................................... $525Part: 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
24.4. Head ArrayAdult, i-Drive Tri-Array Series, 3-Switch ......... $4,414Head Array (IDHBT200-1)Part: ST-IDHBT200-1-Q. HCPCS: E2330Features bluetooth, head support, 3 non-proportional proximity sensors for drive control, an egg switch for re-set mode change, and i-Drive smart box.
Adult, i-Drive Pro Series Head Array .............. $4,461(IDHBT300-1)Part: ST-IDHBT300-1-Q. HCPCS: E2330Features bluetooth, head support with occipital pad and 2 swing-away spot pads for left and right side, 3 non-pro-portional proximity sensors, an egg switch for reset mode change, and i-Drive smart box.
Adult Pro-Series
Enhanced DisplayQ-Logic 3 Enhanced Display ShroudRequired with Q-Logic 3 Enhanced Display selection above. Reference colors shown on page 2.
Black, Soft Touch ..... StandardPart: DGN137728
Red Corvette ..................$60Part: DGN137729-PRD1
Back in Black ..................$60Part: DGN137729-PBK1
Night Train .....................$60Part: DGN137729-PBK3
Grey Street ....................$60Part: DGN137729-PSL3
Deep Purple ...................$60Part: DGN137729-PPR5
Pretty in Pink .................$60Part: DGN137729-PPK3
Midnight Blue .................$60Part: DGN137729-PBU10
Electric Blue ..................$60Part: DGN137729-PBU9
Green Machine ...............$60Part: DGN137729-PGN11
Account Number: ___________ Date: ________________ Marked for: _____________________________________
24.1. Enhanced DisplayQ-Logic 3 Enhanced Display Kit .................................................................................................$1,884.93Part: CTL167726Select 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.
24. ALTERNATIVE CONTROLS AND ELECTRONICSOptional. Select a type of specialty controls below. More options are available on the Alternative Controls and Electronics order form.
Alternative controls and electronics section continued on following page.
Page 16 of 16INFINFB4241/RevC/03AUG2021
24.7. Switch Adapter2 to 1 Switch Adapter .................................................................................................................................................. $13.39Part: DWR1361H037 Connects 2 single switches to a stereo jack to act as a dual switch.
24.8. Environmental Controls
24.9. USB Mobile Device Charger
Q-Logic 3 ECU Module Kit .......................................................................................................... $2,400Part: CTL168057
USB Mobile Device Charger ............................................................................................................ $175Part: ELE168069Can 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
Account Number: ___________ Date: ________________ Marked for: _____________________________________
25. TRU-BALANCE 3 MULTIPLIER HARNESSREQUIRED. Multiple controllers or power accessories may require an additional multiplier harness or special order. Reference the chart below to determine the appropriate selection. The rows refer to the total amount of arm mounted devices and the columns refer to the total amount of back mounted devices. The online order configurator will automatically make this selection under specialty controls.
Secondary Multiplier (SM) ........................................... $221.21Part: XRF000107
1 Arm 2 Arm 3 Arm 4+ Arm
1 Back0 Back
2 Back3+ Back
NANASMSOF
SMSMSMSOF
SMSMSMSOF
SOFSOFSOFSOF
Power Positioning Chart
1 Arm 2 Arm 3 Arm 4+ Arm
1 Back0 Back
2 Back3+ Back
NA
NA No additional MultiplierSecondary MultiplierSpecial Order Required
NASM
SM SOFSOF
SMSMSMSOF
SOFSOFSOFSOF
SOFSOFSOFSOF
Static Seat Chart
Q-Logic 3 Multiplier Charts
Arm
Mou
nts Joystick (Hand Control)
Enhanced DisplayiAccessUSB ChargerSAJ
Back
Mou
nts
Attendant ControlSCIMSip n PuffECU
24. ALTERNATIVE CONTROLS AND ELECTRONICS continued
©2021 Quantum RehabAll rights reserved
facebook.com/QuantumRehab
youtube.com/QuantumRehab
instagram.com/quantum_rehab
twitter.com/quantumrehab