1 of 4All prices are quoted in US dollars. Prices are subject to change without notice.jw=02-27-20
USA ORDER FORMEFFECTIVE MARCH 1, 2020
PURCHASE ORDER #
COMPANY
DATE
CONTACT NAME
SHIP TO
NAME PHONE
ADDRESS
CITY PROV POSTAL CODE
Model #Carbon Fibre
Model # Aluminum
Fits Width
Height$
CarbonQTY
$Aluminum
QTY
NOACB1307 13”-15” 7” 660
NOACB1309 13”-15” 9” 660
NOACB1313 13”-15” 13” 660
NOACB1316 13”-15” 16” 660
NOACB1407 14”-16” 7” 660
NOCFACB1409 NOACB1409 14”-16” 9” 870 660
NOCFACB1413 NOACB1413 14”-16” 13” 900 660
NOCFACB1416 NOACB1416 14”-16” 16” 930 660
NOACB1507 15”-17” 7” 660
NOCFACB1509 NOACB1509 15”-17” 9” 870 660
NOCFACB1513 NOACB1513 15”-17” 13” 900 660
NOCFACB1516 NOACB1516 15”-17” 16” 930 660
NOACB1607 16”-18” 7” 660
NOCFACB1609 NOACB1609 16”-18” 9” 870 660
NOCFACB1613 NOACB1613 16”-18” 13” 900 660
NOCFACB1616 NOACB1616 16”-18” 16” 930 660
NOACB1619 16”-18” 19” 660
NOACB1707 17”-19” 7” 660
NOCFACB1709 NOACB1709 17”-19” 9” 870 660
NOCFACB1713 NOACB1713 17”-19” 13” 900 660
NOCFACB1716 NOACB1716 17”-19” 16” 930 660
NOACB1719 17”-19” 19” 660
NOACB1807 18”-20” 7” 660
NOCFACB1809 NOACB1809 18”-20” 9” 870 660
NOCFACB1813 NOACB1813 18”-20” 13” 900 660
NOCFACB1816 NOACB1816 18”-20” 16” 930 660
NOACB1819 18”-20” 19” 660
NOACB1916 19”-21” 16” 660
NOACB1919 19”-21” 19” 660
NOACB2007 20”-22” 7” 660
NOCFACB2009 NOACB2009 20”-22” 9” 870 660
NOCFACB2013 NOACB2013 20”-22” 13” 900 660
NOCFACB2016 NOACB2016 20”-22” 16” 930 660
NOACB2019 20”-22” 19” 660
TH
OR
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IC S
HA
PE
Optima™ THORACIC BACK SUPPORT
Model # Carbon Fibre
Model #Aluminum
Fits Width
Height$
CarbonQTY
$Aluminum
QTY
NOPCB1307 13”-15” 7” 660
NOPCB1309 13”-15” 9” 660
NOPCB1313 13”-15” 13” 660
NOPCB1316 13”-15” 16” 660
NOPCB1407 14”-16” 7” 660
NOCFPCB1409 NOPCB1409 14”-16” 9” 965 660
NOCFPCB1413 NOPCB1413 14”-16” 13” 985 660
NOCFPCB1416 NOPCB1416 14”-16” 16” 1025 660
NOPCB1507 15”-17” 7” 660
NOCFPCB1509 NOPCB1509 15”-17” 9” 965 660
NOCFPCB1513 NOPCB1513 15”-17” 13” 985 660
NOCFPCB1516 NOPCB1516 15”-17” 16” 1025 660
NOPCB1607 16”-18” 7” 660
NOCFPCB1609 NOPCB1609 16”-18” 9” 965 660
NOCFPCB1613 NOPCB1613 16”-18” 13” 985 660
NOCFPCB1616 NOPCB1616 16”-18” 16” 1025 660
NOPCB1619 16”-18” 19” 660
NOPCB1707 17”-19” 7” 660
NOCFPCB1709 NOPCB1709 17”-19” 9” 965 660
NOCFPCB1713 NOPCB1713 17”-19” 13” 985 660
NOCFPCB1716 NOPCB1716 17”-19” 16” 1025 660
NOPCB1719 17”-19” 19” 660
NOPCB1807 18”-20” 7” 660
NOCFPCB1809 NOPCB1809 18”-20” 9” 965 660
NOCFPCB1813 NOPCB1813 18”-20” 13” 985 660
NOCFPCB1816 NOPCB1816 18”-20” 16” 1025 660
NOPCB1819 18”-20” 19” 660
NOPCB1916 19”-21” 16” 660
NOPCB1919 19”-21” 19” 660
NOPCB2007 20”-22” 7” 660
NOCFPCB2009 NOPCB2009 20”-22” 9” 965 660
NOCFPCB2013 NOPCB2013 20”-22” 13” 985 660
NOCFPCB2016 NOPCB2016 20”-22” 16” 1025 660
NOPCB2019 20”-22” 19” 660
Optima™ DEEP THORACIC BACK SUPPORT
CARBON FIBRE SHELL = WEIGHT SAVINGS UP TO 2.4 LBS WITH FIXED MICRO-MOUNT HARDWARE OPTION
CARBON FIBRE SHELL = WEIGHT SAVINGS UP TO 2.4 LBS WITH FIXED MICRO-MOUNT HARDWARE OPTION
HCPCS CODE: E2620-E2621 HCPCS CODE: E2620-E2621
2 of 4All prices are quoted in US dollars. Prices are subject to change without notice.jw=02-27-20
Model #Carbon Fibre
Model # Aluminum
Fits Width
Height$
CarbonQTY
$Aluminum
QTY
N/A NOACB2116 21”- 23” 16” N/A 660N/A NOACB2119 21”- 23” 19” N/A 660N/A NOACB2213 22”- 24” 13” N/A 710N/A NOACB2216 22”- 24” 16” N/A 710N/A NOACB2219 22”- 24” 19” N/A 710 N/A NOACB2316 23”- 25” 16” N/A 710N/A NOACB2319 23”- 25” 19” N/A 710N/A NOACB2416 24”-26” 16” N/A 710N/A NOACB2419 24”-26” 19” N/A 710N/A NOACB2516 25”-27” 16” N/A 710N/A NOACB2519 25”-27” 19” N/A 710N/A NOACB2616 26”-28” 16” N/A 710N/A NOACB2619 26”-28” 19” N/A 710N/A NOACB2716 27”-29” 16” N/A 710N/A NOACB2719 27”-29” 19” N/A 710N/A NOACB2816 28”-30” 16” N/A 710N/A NOACB2819 28”-30” 19” N/A 710N/A NOACB2916 29” - 30” 16” N/A 710N/A NOACB2919 29” - 30” 19” N/A 710
Model #Carbon Fibre
Model # Aluminum
Fits Width
Height$
Carbon QTY $
Aluminum QTY
N/A NOPCB2116 21”- 23” 16” N/A 660N/A NOPCB2119 21”- 23” 19” N/A 660N/A NOPCB2213 22”- 24” 13” N/A 710N/A NOPCB2216 22”- 24” 16” N/A 710N/A NOACB2219 22”- 24” 19” N/A 710N/A NOACB2316 23”- 25” 16” N/A 710N/A NOACB2319 23”- 25” 19” N/A 710N/A NOACB2416 24”-26” 16” N/A 710N/A NOACB2419 24”-26” 19” N/A 710N/A NOACB2516 25”-27” 16” N/A 710N/A NOACB2519 25”-27” 19” N/A 710N/A NOACB2616 26”-28” 16” N/A 710N/A NOACB2619 26”-28” 19” N/A 710N/A NOACB2716 27”-29” 16” N/A 710N/A NOACB2719 27”-29” 19” N/A 710N/A NOACB2816 28”-30” 16” N/A 710N/A NOACB2819 28”-30” 19” N/A 710N/A NOACB2916 29” - 30” 16” N/A 710N/A NOACB2919 29” - 30” 19” N/A 710
TH
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IC S
HA
PE
Xtend™ Fits Width Height $ QTY
NHAACB1616/20 16”-18” 16”-20” 660
NHAACB1816/20 18”-20” 16”-20” 660
NHAACB2016/20 20”-22” 16”-20” 660
NHAACB2216/20 22”-24” 16”-20” 710
NHAACB2416/20 24”-26” 16”-20” 710
Xtend™
Xtend™ HEIGHT ADJUSTABLE THORACIC BACK SUPPORT
Optima™ THORACIC BACK SUPPORT HCPCS CODE: E2620-E2621
Xtend™ DEEP HEIGHT ADJUSTABLE THORACIC BACK SUPPORT
Optima™ DEEP THORACIC BACK SUPPORT HCPCS CODE: E2620-E2621
Xtend™ Fits Width Height $ QTY
NHAPCB1616/20 16”-18” 16”-20” 660
NHAPCB1816/20 18”-20” 16”-20” 660
NHAPCB2016/20 20”-22” 16”-20” 660
NHAPCB2216/20 22”-24” 16”-20” 710
NHAPCB2416/20 24”-26” 16”-20” 710
Xtend™ DEEP
Xtend™ LOW Fits Width Height $ QTY
NHAACB (L) 1213/17 12”-14” 13”-17” 660
NHAACB (L) 1413/17 14”-16” 13”-17” 660
NHAACB (L) 1613/17 16”-18” 13”-17” 660
NHAACB (L) 1813/17 18”-20” 13”-17” 660
NHAACB (L) 2013/17 20”-22” 13”-17” 660
NHAACB (L) 2213/17 22”-24” 13”-17” 710
Xtend™ KIDS Fits Width Height $ QTY
NHAKCB10/8-10.5 10” 8”-10.5” 625
NHAACB (L) 1413/17 12” 9”-11.5” 625
NHAACB (L) 1613/17 14” 10”-12.5” 625
Xtend™ LOW DEEP Fits Width Height $ QTY
NHAPCB (L) 1213/17 12”-14” 13”-17” 660
NHAPCB (L) 1413/17 14”-16” 13”-17” 660
NHAPCB (L) 1613/17 16”-18” 13”-17” 660
NHAPCB (L) 1813/17 18”-20” 13”-17” 660
NHAPCB (L) 2013/17 20”-22” 13”-17” 660
NHAPCB (L) 2213/17 22”-24” 13”-17” 710
Xtend™ LOW
Xtend™ KIDS
Xtend™ LOW HEIGHT ADJUSTABLE THORACIC BACK SUPPORT
Xtend™ KIDS HEIGHT ADJUSTABLE THORACIC BACK SUPPORT
Xtend™ LOW DEEP HEIGHT ADJUSTABLE THORACIC BACK SUPPORT
Xtend™ LOWDEEP
notes
HCPCS CODE: E2620-E2621
HCPCS CODE: E2620-E2621
HCPCS CODE: E2620-E2621
HCPCS CODE: E2620-E2621
HCPCS CODE: E2620-E2621
3 of 4All prices are quoted in US dollars. Prices are subject to change without notice.jw=02-27-20
PE
LV
IC
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AP
EC
US
TO
MIZ
AB
LE
PE
LV
IC S
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CU
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HO
RA
CIC
S
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PE
Classic™ PELVIC BACK SUPPORT
Classic™ FitsWidth Height $ QTY
NACB1616 16”-18” 16” 660NACB1618 16”-18” 18” 660NACB1620 16”-18” 20” 660NACB1816 18”-20” 16” 660NACB1818 18”-20” 18” 660NACB1820 18”-20” 20” 660NACB2016 20”-22” 16” 660NACB2018 20”-22” 18” 660NACB2020 20”-22” 20” 660NACB2216 22”-24” 16” 710NACB2218 22”-24” 18” 710NACB2220 22”-24” 20” 710
Classic™ DEEP PELVIC BACK SUPPORT
Classic™ DEEP Fits Width Height $ QTY
NPCB1616 16”-18” 16” 660NPCB1618 16”-18” 18” 660NPCB1620 16”-18” 20” 660NPCB1816 18”-20” 16” 660NPCB1818 18”-20” 18” 660NPCB1820 18”-20” 20” 660NPCB2016 20”-22” 16” 660NPCB2018 20”-22” 18” 660NPCB2020 20”-22” 20” 660NPCB2216 22”-24” 16” 710NPCB2218 22”-24” 18” 710NPCB2220 22”-24” 20” 710
Classic™ DEEPClassic™
üFit™ CUSTOMIZABLE PELVIC BACK SUPPORT
üFit™ Fits Width Height $ QTY
NOUFACB1416 14”-16” 16” 895
NOUFACB1418 14”-16” 18” 895NOUFACB1420 14”-16” 20” 895NOUFACB1616 16”-18” 16” 895NOUFACB1618 16”-18” 18” 895NOUFACB1620 16”-18” 20” 895NOUFACB1816 18”-20” 16” 895NOUFACB1818 18”-20” 18” 895NOUFACB1820 18”-20” 20” 895NOUFACB2016 20”-22” 16” 895NOUFACB2018 20”-22” 18” 895NOUFACB2020 20”-22” 20” 895NOUFACB2216 22”-24” 16” 995NOUFACB2218 22”-24” 18” 995NOUFACB2220 22”-24” 20” 995
Optional Incontinent/Infection Control Cover
üFit™
üFit™ DEEP CUSTOMIZABLE PELVIC BACK SUPPORT
üFit™ DEEP Fits Width Height $ QTY
NOUFPCB1416 14”-16” 16” 995
NOUFPCB1418 14”-16” 18” 995NOUFPCB1420 14”-16” 20” 995NOUFPCB1616 16”-18” 16” 995NOUFPCB1618 16”-18” 18” 995NOUFPCB1620 16”-18” 20” 995NOUFPCB1816 18”-20” 16” 995NOUFPCB1818 18”-20” 18” 995NOUFPCB1820 18”-20” 20” 995NOUFPCB2016 20”-22” 16” 995NOUFPCB2018 20”-22” 18” 995NOUFPCB2020 20”-22” 20” 995NOUFPCB2216 22”-24” 16” 1195NOUFPCB2218 22”-24” 18” 1195NOUFPCB2220 22”-24” 20” 1195Optional Incontinent/Infection Control Cover
üFit™ DEEP
üFit™ II DEEP CUSTOMIZABLE THORACIC BACK SUPPORT
üFit II™ DEEP Fits Width
Back Height $ QTY
NOUFXPCB1416 14”-16” 16” 1045
NOUFXPCB1418 14”-16” 18” 1045NOUFXPCB1420 14”-16” 20” 1045NOUFXPCB1616 16”-18” 16” 1045NOUFXPCB1618 16”-18” 18” 1045NOUFXPCB1620 16”-18” 20” 1045NOUFXPCB1816 18”-20” 16” 1045NOUFXPCB1818 18”-20” 18” 1045NOUFXPCB1820 18”-20” 20” 1045NOUFXPCB2016 20”-22” 16” 1045NOUFXPCB2018 20”-22” 18” 1045NOUFXPCB2020 20”-22” 20” 1045NOUFXPCB2216 22”-24” 16” 1195NOUFXPCB2218 22”-24” 18” 1195NOUFXPCB2220 22”-24” 20” 1195Optional Incontinent/Infection Control Cover
üFit II™ DEEP
üFit™ II CUSTOMIZABLE THORACIC BACK SUPPORT
üFit II™ Fits Width
Back Height $ QTY
NOUFXACB1416 14”-16” 16” 945
NOUFXACB1418 14”-16” 18” 945NOUFXACB1420 14”-16” 20” 945NOUFXACB1616 16”-18” 16” 945NOUFXACB1618 16”-18” 18” 945NOUFXACB1620 16”-18” 20” 945NOUFXACB1816 18”-20” 16” 945NOUFXACB1818 18”-20” 18” 945NOUFXACB1820 18”-20” 20” 945NOUFXACB2016 20”-22” 16” 945NOUFXACB2018 20”-22” 18” 945NOUFXACB2020 20”-22” 20” 945NOUFXACB2216 22”-24” 16” 995NOUFXACB2218 22”-24” 18” 995NOUFXACB2220 22”-24” 20” 995Optional Incontinent/Infection Control Cover
üFit II™
HCPCS CODE: E2620-E2621 HCPCS CODE: E2620-E2621
HCPCS CODE: E2620-E2621 HCPCS CODE: E2620-E2621
HCPCS CODE: E2620-E2621HCPCS CODE: E2620-E2621
4 of 4All prices are quoted in US dollars. Prices are subject to change without notice.jw=02-27-20
Armadillo™ VICAIR
Fits Width
Back Height $ QTY
NVMAPSB14 14”-16” 16”NVMAPSB16 16”-18” 16”
NVMAPSB18 18”-20” 18”
NVMAPSB20 20”-22” 18”
Armadillo™ Fits Width
Back Height $ QTY
NMAPSB14 14”-16” 16” 835NMAPSB16 16”-18” 16” 835
NMAPSB18 18”-20” 18” 835
NMAPSB18-TALL 18”-20” 20” 835
NMAPSB20 20”-22” 18” 835NMAPSB20-TALL 20”-22” 20” 835NMAPSB22 22”-24” 18” 945
NMAPSB22-TALL 22”-24” 20” 945
NMAPSB24 24”-26” 18” 945
NMAPSB24-TALL 24”-26” 20” 945
CU
ST
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BL
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AP
EArmadillo™ BACK SUPPORT with VICAIR® TECHNOLOGY CUSHION
Model No. $ QTY
NIB-1937 - 2” Lateral Contour Add-On (Pair) 90
Armadillo™ ADDITIONAL LATERAL CONTOUR ADD-ON
Armadillo™ BACK SUPPORT
Armadillo
VC
VC™ BACK SUPPORT - VICAIR TECHNOLOGY CUSHION
VC Fits Width
Back Height $ QTY
NVCB1616 16”-18 16”NVCB1620 16”-18” 20”
NVCB1816 18”-20” 16”
NVCB1820 18”-20” 20”NVCB2016 20”-22” 16”NVCB2020 20”-22” 20”
MultiFit™ HEAD SUPPORTMODEL NO. MULTI-ADJUSTABLE PADS $ QTY
NIB-0785 9” x 5” CONTOURED 195
NIB-0784 10” x 5” LARGE RECTANGULAR 195
NIB-0818 14” x 5” EXTRA-LARGE RECTANGULAR 195
MODEL NO. FEATURES $ QTY
NIB-0747 MULTI-AXIS HARDWARE 145
NIB-0823 HEAD SUPPORT RECEIVER BRACKET 55
NIB-1306 FLIP BACK MULTI-AXIS HARDWARE 250
NIB-1210 FLIP BACK KIT 105
NIB-1200 UNIVERSAL HEAD SUPPORT ADAPTER 65
Contoured(NIB-0785)
Large(NIB-0784)
Extra large(NIB-0818)
Multi-Axis Hardware(NIB-0747)
Head Support Receiver Bracket (NIB-0823)
BACK SUPPORT HARDWARE OPTIONS
• ALL BACKS COME STANDARD WITH QUICK RELEASE MOUNTING HARDWARE• THE FIXED MOUNTING HARDWARE OPTIONS BELOW ARE NO-CHARGE SUBSTITUTIONS FOR THE STANDARD HARDWARE.
Model No. Description Optima™ Optima™
Carbon Xtend™ Xtend™
LOWXtend™
Kids Classic™ üFit™ Armadillo QTY
NIB-1207 2 Point fixed hardware
Optional 1 Optional N/A N/A N/A Optional
1Optional
1 N/A
NIB-1642
Micro Mount 2 Point
fixed hardware
Optional 2 & 3
Optional 2 & 3 N/A N/A N/A N/A N/A N/A
NIB-1307 4 Point fixed hardware
Optional 3
Optional 3
Optional 3 & 4
Optional 3 & 4 N/A Optional
3Optional
3 N/A
NOTE: 1 – Use only on back supports with 16” (40.6cm) back height or lower. 2 – Use only on back supports with 13” (33cm) back height or lower. 3 – Not width adjustable - fits one back/chair width. 4 – Limits height adjustment to 3”
4-point fixed hardware
2-point fixed hardware
2-point micro mount
notes
HCPCS CODE: E2620-E2621
HCPCS CODE: E0955
NOT AVAILABLE IN USA
NOT AVAILABLE IN USA
5 of 4All prices are quoted in CDN dollars. Prices are subject to change without notice
NüFit™ Fits Width Fits Depth $ QTY
NXCANF1616 15”, 16” 16” 395
NXCANF1618 15”, 16” 18” 395
NXCANF1620 15”, 16” 20” 395
NXCANF1816 17”, 18” 16” 395
NXCANF1818 17”, 18” 18” 395
*NXCANF1820 17”, 18” 20” 395
*NXCANF2016 19”, 20” 16” 395
*NXCANF2018 19”, 20” 18” 395
*NXCANF2020 19”, 20” 19” 395
*NXCANF2216 21”, 22” 21” 425
*NXCANF2218 21”, 22” 21” 425
*NXCANF2220 21”, 22” 21” 425
Optional Incontinent/Infection Control Cover
BioFit™ Fits Width Fits Depth $ QTY
NXCABF1010 10” 10” 425NXCABF1012 10” 12” 425NXCABF1014 10” 14” 425NXCABF1210 11”, 12” 10” 425NXCABF1212 11”, 12” 12” 425NXCABF1214 11”, 12” 14” 425NXCABF1412 13”, 14” 12” 425NXCABF1414 13”, 14” 14” 425NXCABF1416 13”, 14” 16” 425NXCABF1616 15”, 16” 16” 425NXCABF1618 15”, 16” 18” 425NXCABF1620 15”, 16” 20” 425NXCABF1816 17”, 18” 16” 425NXCABF1818 17”, 18” 18” 425NXCABF1820 17”, 18” 20” 425NXCABF1822 17”, 18” 22” 425NXCABF1822 17”, 18” 22” 425NXCABF2016 19”, 20” 16” 425NXCABF2018 19”, 20” 18” 425NXCABF2020 19”, 20” 20” 425NXCABF2022 19”, 20” 20” 425NXCABF2022 19”, 20” 22” 425NXCABF2216 21”, 22” 16” 455NXCABF2218 21”, 22” 18” 455NXCABF2220 21”, 22” 20” 455NXCABF2222 21”, 22” 22” 455NXCABF2222 21”, 22” 22” 455NXCABF2416 23”, 24” 16” 455NXCABF2418 23”, 24” 18” 455NXCABF2420 23”, 24” 20” 455NXCABF2422 23”, 24” 22” 455NXCABF2616 23”, 24” 16” 455NXCABF2618 25”, 26” 18” 455NXCABF2620 25”, 26” 20” 455NXCABF2622 25”, 26” 20” 455
Optional Incontinent/Infection Control Cover
BioFit™
CUSHIONS
753011 Second Line EHS, Orangeville, ON L9W 5W4T: (866) 875-2877 / (519) 942-8441 I F: (866) 875-2878 / (519) 942-2186 I E: [email protected] www.DynamicHCS.com
HCPCS CODE: E0955
NüFit™
HCPCS CODE: E0955