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Page 1 of 7INFINFB3736/RevD/21MAY2020
Jazzy® 1450 — Group 2 Very Heavy-Duty Order FormAccount Number: ___________ Date: ________________
Provider Name: __________________________________
Contact: ________________________________________
Phone: ___________________ Fax: _________________
Email: __________________________________________
PO Number: _____________________________________
Marked for: _____________________________________
Ship to Address: _________________________________
City: _____________________ State: ______ Zip: ______
This form is interactive when viewed in Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for determining 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. Pride Providers may contact Technical Service for accurate parts ordering.
Thank you for choosing Pride Mobility Products!
INTRODUCTION
Candy Apple RedPart: SHDASMB6703
Viper BluePart: SHDASMB6704
BASE COLORREQUIRED. Select one shroud color. Colors shown here may differ from actual product depending on monitor/printer calibration used.
Jazzy 1450 2VHD-C......................................................... $6,499Part: J1450 2VHD-C. HCPCS: K0827 - Group 2 Very Heavy-DutyCaptain Seating
Jazzy 1450 2VHD-SS ...................................................... $6,499Part: J1450 2VHD-SS. HCPCS: K0826 - Group 2 Very Heavy-DutySolid Seat Pan Seating
BASE MODELREQUIRED. Select a power base. Weight capacity: 600 lbs. Find more details and specifications at pridemobility.com/jazzy-1450.
Standard Features• Front-wheel drive• 14″ × 4″ solid tires• 8-amp off-board charger
17″W × 13″D ............................Standard Part: FRMASMB17955
17″W × 16″D ........................ No ChargePart: FRMASMB17956
Omit Foot Platform ........... No ChargePTOINDV3674
FOOT PLATFORMREQUIRED. Only one foot platform may be selected.
Pride® Mobility Products Corporation401 York Avenue, Duryea, PA 18642Phone: 1-800-800-8586 | Fax: 1-800-800-1636 | Email: [email protected]
Page 2 of 7INFINFB3736/RevD/21MAY2020
Account Number: ___________ Date: ________________ Marked for: _____________________________________
ELECTRONICSREQUIRED. Select a type of drive control from the following sections.
90-amp VR2 6-key .........................................................................................................................................................................StandardPart: CTLDC1498
Non-Expandable ControlsNon-expandable controls do not allow supplementary drive controllers.
Q-Logic 2 EX Joystick ....................................$700Part: CTL123217
No Joystick, Setup for Q-LogicPart: N/A
Stand-Alone Joystick .....................................$700With External Charger PortPart: ELEASMB5205Up to three drive profiles and one seating profile when used alone. Use in conjunction with Enhanced Display for up to five profiles and auxiliary functions such as Bluetooth mouse and IR. Includes charger port mounting bracket and multiplier box harness. Stand-Alone Joystick
Q-Logic 2 EX ArmorREQUIRED with Q-Logic 2 EX Joystick selection above. Reference colors shown in BASE COLOR on Page 1. Additional shroud colors are available. Contact sales for pricing.
Black Soft Touch ..................StandardPart: DGN124336-PBK1
Candy Apple Red ...........................$50Part: DGN124336-PRD1
Viper Blue .......................................$50Part: DGN124336-PBU1
Q-Logic 2 Joystick
Q-Logic 2 EXController Module
Q-Logic 2 EX Controller Module ...................$695Part: ELE136028
Q-Logic 2 EX Controller Harness .................$425Part: DWR1111H065
Q-Logic 2 Required ComponentsQ-Logic 2 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.
Expandable ControlsExpandable controls allow multiple or specialized controllers. This section allows a selection of common configurations.
PROGRAMMINGOptional.
P&G Handheld Programmer .......$423Works with VR2 6-key only.Part: CTLDC1388
Q-Logic Handheld Programmer ..$545Works with Q-Logic 2 EX only.Part: ELEASMB6976
Q-Logic Programming Cable .....$750With disk; works with Q-Logic 2 EX only.Part: ELEASMB5216
BATTERIESREQUIRED. The Power Chair requires two batteries.
Group 24, 70-amp, Gel ...................................................................................................................................................................$365 ea.Part: BAT1704614. HCPCS: E2363
Page 3 of 7INFINFB3736/RevD/21MAY2020
JOYSTICK HANDLESOptional.
Joystick Handles
Mushroom Handle (A) ......................................$85Part: ACCASMB1860. HCPCS: E2323
Chin Cup (B) .......................................................$85Part: ACCASMB1861. HCPCS: E2323(HCPCS: E2324 with chin control)
T-Bar (C) ........................................................... $120Part: ACCASMB1858. HCPCS: E2323
Medium Ball Handle (D) ...................................$65Part: ACCASMB1859. HCPCS: E2323
Soft Ball Handle (E) ..........................................$65Part: ACCASMB1856. HCPCS: E2323
Extended I-Handle (F) ......................................$85Part: ACCASMB1857. HCPCS: E2323
Bodypoint 3″ Goal Post Handle ......................$99Part: PLSKNCP1057. HCPCS: E2323
Bodypoint 4″ Goal Post Handle ......................$99Part: PLSKNCP1058. HCPCS: E2323
JOYSTICK MOUNTING BRACKETSREQUIRED. Select a mount to be used with a joystick selected in previous section.
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Swing-Away JoystickIn-line Mount (Right)
Swing-Away JoystickOffset Mount (Right)
Omit Joystick Mounting Bracket or See Positioning Components Order Form.
Fixed, In-line, Q-Logic ............................StandardPart: FRMASMB10617
Fixed, In-line Bracket, VR2 ................... StandardPart: FRMASMB9532
Left-Side MountPart: PTOINDV1225
Right-Side MountPart: PTOINDV1226
Swing-Away, In-line, Left, VR2......................$245Part: ACC142529. HCPCS: E1028
Swing-Away, In-line, Left, Q-Logic ...............$245Part: ACC142738. HCPCS: E1028
Swing-Away, In-line, Right, VR2 ...................$245Part: ACC142530. HCPCS: E1028
Swing-Away, In-line, Right, Q-Logic ............$245Part: ACC142739. HCPCS: E1028
Swing-Away, 1″ Offset, Left, VR2 .................$245Part: ACC142749. HCPCS: E1028
Swing-Away, 1″ Offset, Left, Q-Logic ..........$245Part: ACC142745. HCPCS: E1028
Swing-Away, 1″ Offset, Right, VR2 ...............$245Part: ACC142750. HCPCS: E1028
Swing-Away, 1″ Offset, Right, Q-Logic ........$245Part: ACC142746. HCPCS: E1028
Swing-Away (Retractable) BracketAllows the joystick to retract to the side of the armrest while maintaining the same joystick orientation. In-line bracket will be offset 1″ when used with tube-style armrests. Select Offset bracket to have the joystick in-line with armpad on tube-style armrests.
Fixed, In-line Joystick BracketSelect a bracket and a side on which to mount it.
Multi-Axis
Retract 4
Retract 4 Mount ...............................................$350Q-Logic Part: MEC138860. HCPCS: E1028
Full 180° of movement that translates into multi-position use, straight, right offset, left offset, or fold-away. Joystick orientation varies as bracket is adjusted.
Multi-Axis Mount .............................................$100Q-Logic Part: ACC131216. HCPCS: E1028Allows height adjustment of joystick.
Specialty Joystick MountsSelect a bracket and side on which to mount it.
Left-Side MountPart: PTOINDV1225
Right-Side MountPart: PTOINDV1226
Mount Side
Mount Side
JOYSTICK RECEIVERREQUIRED with Heavy-Duty Contoured Seating.
Universal Joystick Receiver MountPart: FRMASMB16062
Omit Joystick Receiver MountPart: N/A
Page 4 of 7INFINFB3736/RevD/21MAY2020
Account Number: ___________ Date: ________________ Marked for: _____________________________________
CONTOURED SEATINGOptional. Select one seat. High-back seats are black vinyl.
Solid Seat Pan Seating — Pinchless Hinge, High-Back with Solid Seat PanSeats do not include a lumbar cutout.
22″W × 20″D .................................................................. StandardPart: SETASMB2985
22″W × 22″D .................................................................. StandardPart: SETASMB2986
Captain Seating — Pinchless Hinge, High-BackSeats do not include a lumbar cutout.
22″W × 20″D .................................................................. StandardPart: SETASMB2382
24″W × 20″D .................................................................. StandardPart: SETASMB2387
24″W × 22″D .................................................................. StandardPart: SETASMB2388
24″W × 24″D .................................................................. StandardPart: SETASMB2389
HEAVY-DUTY CONTOURED SEATING — Captain Seating, High Back with HeadrestOptional. Select one seat. High-back seats are black vinyl. Seats include a lumbar cutout.
26″W × 20″D ........................................................................ $1000Part: SETASMB4566
26″W × 22″D ....................................................................... $1,000Part: SETASMB4567
ARMRESTS — Flip-up, Height-Adjustable, RemovableREQUIRED with Pinchless Hinge seats. Not available with Heavy-Duty Seats. Select a Left and Right Armrest.See Page 5 for Heavy-Duty Armrests.
Full-Length, Left ............................................................. $85 ea.Part: FRMASMB8614. HCPCS: E0973
Full-Length, Right .......................................................... $85 ea.Part: FRMASMB8615. HCPCS: E0973
Desk-Length, Left .......................................................... $85 ea.Part: FRMASMB8612. HCPCS: E0973
Desk-Length, Right ........................................................ $85 ea.Part: FRMASMB8613. HCPCS: E0973Not available with Depth-Adjustable seats.
Page 5 of 7INFINFB3736/RevD/21MAY2020
HEAVY-DUTY ARMPADSStraight, Full-Length, Left and Right ...................... StandardPart: UPSASMB1021
Straight, Full-Length/Desk-Length ......................... StandardPart: UPSASMB1023
Straight, Desk-Length, Left and Right .................... StandardPart: UPSASMB1022
Waterfall, Full-Length, Left and Right .................... StandardPart: UPSASMB1024
Waterfall, Full-Length/Desk-Length ........................ StandardPart: UPSASMB1026
Waterfall, Desk-Length, Left and Right .................. StandardPart: UPSASMB1025
Flat Bariatric (pair) ..................................................... StandardPart: UPSASMB1027Only available with Bariatric, Height-Adjustable, Removable Armrests
6″W × 11″D .............................................................................$170Part: FRMASMB4741
8″W × 11″D .............................................................................$170Part: FRMASMB4744
Angle-Adjustable Footplates
Wheel Bumpers (pair) ............................................................................................................................................................................$25Part: WHLASMB1578
AccessoriesMay require seating configuration adjustments to avoid front caster interference.
12″ – 14.5″ LengthPart: FRMASMB4752
14.5″ – 18″ LengthPart: FRMASMB4753
17.5″ – 21″ LengthPart: FRMASMB4754
Lower Extensions
LEG RESTSOptional. Some adjustments may be needed upon receipt of the unit.
Heavy-Duty Drop-in, 12″ – 14.5″ Extension .................... $420Part: FRMASMB4762
Heavy-Duty Drop-in, 14.5″ – 18″ Extension .................... $420Part: FRMASMB4853
Heavy-Duty Drop-in Leg RestsOnly available with Heavy-Duty seats.
8″ – 12″ Full-Length, Left ............................................... $85 ea.Part: FRMASMB9982. HCPCS: E0973
8″ – 12″ Full-Length, Right ............................................. $85 ea.Part: FRMASMB9983. HCPCS: E0973
10″ – 14″ Full-Length, Left.............................................. $85 ea.Part: FRMASMB9986. HCPCS: E0973
10″ – 14″ Full-Length, Right ........................................... $85 ea.Part: FRMASMB9987. HCPCS: E0973
8″ – 12″ Desk-Length, Left ............................................. $85 ea.Part: FRMASMB9984. HCPCS: E0973
8″ – 12″ Desk-Length, Right........................................... $85 ea.Part: FRMASMB9985. HCPCS: E0973
10″ – 14″ Desk-Length, Left ........................................... $85 ea.Part: FRMASMB9988. HCPCS: E0973
10″ – 14″ Desk-Length, Right ......................................... $85 ea.Part: FRMASMB9989. HCPCS: E0973
Single Post, Height-Adjustable, Removable, Heavy-Duty Armrests
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Bariatric, Height-Adjustable, Removable ArmrestsRequires Flat Bariatric Armpads.
8″ – 12″ Full-Length, Left ............................................... $85 ea.Part: FRMASMB6728. HCPCS: E0973
8″ – 12″ Full-Length, Right ............................................. $85 ea.Part: FRMASMB6729. HCPCS: E0973
10″ – 14″ Full-Length, Left .............................................. $85 ea.Part: FRMASMB6730. HCPCS: E0973
10″ – 14″ Full-Length, Right ........................................... $85 ea.Part: FRMASMB6731. HCPCS: E0973
HEAVY-DUTY ARMRESTSREQUIRED with Heavy-Duty Seats. Not available with Pinchless Hinge Seats. Select a Left and Right Armrest.
Page 6 of 7INFINFB3736/RevD/21MAY2020
ACCESSORIESOptional.
Saddle Bag .............................................................................$35Part: DWR1020D010
Weather Cover .....................................................................$168Part: ACCCOVR1022
Flag Holder for Pinchless Hinge Seats ..............................$25Part: ACCASMB1907
Flag Holder for Heavy-Duty Seats ......................................$25Part: ACCASMB2415
Cup Holder .............................................................................$20Part: ACCASMB2634Only available with Pinchless Hinge Seats
Quantum Cup Holder ...........................................................$20Part: ACCASMB2632Only available with Heavy-Duty Seats
Tablet Holder .......................................................................$315Part: ACC7120005Only available with Heavy-Duty Seats
Cell Phone/Media Holder ...................................................$140Part: ACC7120006Only available with Heavy-Duty Seats
BACK-MOUNTED ACCESSORIESOptional. Only one back-mounted accessory can be used at time. Includes mounting bracket and hardware.
Rear Basket for Pinchless Hinge Seats ...........................$118Part: FRMASMB1280
Rear Basket for Heavy-Duty Seats ...................................$118Part: FRMASMB4821
Cane/Crutch Holder for Pinchless Hinge Seats .............$110Part: FRMASMB1270. HCPCS: E2207
Cane/Crutch Holder for Heavy-Duty Seats .....................$110Part: FRMASMB4822. HCPCS: E2207
Oxygen Tank Holder for Pinchless Hinge Seats ............$118Part: FRMASMB1269. HCPCS: E2208
Oxygen Tank Holder for Heavy-Duty Seats ....................$118Part: FRMASMB7030. HCPCS: E2208
Walker Holder Pinchless Hinge Seats .............................$103Part: FRMASMB1271
Walker Holder for Heavy-Duty Seats ...............................$103Part: FRMASMB7031
Lowest Hole PositionPart: PTOINDV3558
Middle Hole PositionPart: PTOINDV3559
Highest Hole PositionPart: PTOINDV3560
SEAT-TO-FLOOR HEIGHTREQUIRED.
Lowest20.5˝17.5˝21.5˝18.5˝
Jazzy 1450 Seat-to-Floor Height Chart
Middle21.5˝18.5˝22.5˝19.5˝
Highest22.5˝19.5˝23.5˝20.5˝
Seat Type Seat-to-Floor Heights
Contoured, High-BackContoured, High-Back with SSPHeavy-Duty High-BackHeavy-Duty High-Back with SSP
Account Number: ___________ Date: ________________ Marked for: _____________________________________
50″ Lap BeltPart: ACCBELT1000
60″ Lap BeltPart: ACCBELT1002
70″ Lap BeltPart: ACCBELT1003
80″ Lap BeltPart: ACCBELT1004
90″ Lap BeltPart: ACCBELT1001
LAP BELTS
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
Page 7 of 7INFINFB3736/RevD/21MAY2020
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
REFERENCE ORDER FORMSOptional. Select below to note that additional order forms will accompany this order form.
© 2020 Pride Mobility Products Corp. All rights reserved.
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NOTES
See cushion order form Synergy Seat (Not a Quick Ship option)
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Pride® Mobility Products Corporation401 York Avenue, Duryea, PA 18642Phone: 1-800-800-8586 | Fax: 1-800-800-1636 | Email: [email protected]