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Company: ________________________________________________
Account Number: __________________ Date: _________________
q Quote q PO Number: ___________________________________
RTS: _____________________________________________________
Marked For: _______________________________________________
Ship To: __________________________________________________
Address: _________________________________________________
City: ________________________________ State: _____________
Zip: ________________ Phone: _____________________________
Email/Fax: ________________________________________________
Frame
Seat Width / Seat DepthSelect box corresponding to desired Seat Width and Depth
Seat Width
14” 15” 16” 17” 18” 19” 20” 21” 22”
PriceHCPCS
$45 $45 N/C $45 N/C $150$395E2201
$495E2201
$495E2201
Sea
t D
epth
14” N/C q q q q q q q q q15” $70 q q q q q q q q q16” N/C q q q q q q q q q17” $90 q q q q q q q q q18” N/C q q q q q q q q q19” $195 q q q q q q q q q20” $450
E2203 q q q q q q q q q
Heavy Duty Option
q 350 lb Weight Capacity __________________________________________________________________ $500Requires minimum 6” caster height
Cross Brace
q Standard Cross Braces _____________________________________________________________________ Stdq Seating System Cross Braces _______________________________________________________ N/C
Allows for easy attachment of seating system mounting hardware. Not available with Seat Sling.
Catalyst 4C K0004 ______________________________________________________________________ $1525250 lb weight capacity
Backrest
Back Post / Height Range / Back HeightSelect Back Height in row corresponding to desired Back Post and Height Range
BackPost
Price Height Range
Back Height
Standard N/C
Short q 8.5 q 9.5 q 10.5 q 11.5
Medium q 12.5 q 13.5 q 14.5 q 15.5
Tall q 16.5 q 17.5 q 18.5 q 19.5
Angle Adjustable w/ Push Handle
$185
Short q 14 q 15 q 16
Medium q 16 q 17 q 18
Tall q 18 q 19 q 20
Standard Back PostSelect option below only if a Standard Back Post option is selected on chart at left
q Straight with Push Handle ________________________________________________________________ Stdq Straight without Push Handle ________________________________________________________ N/Cq 8º Bend with Push Handle ______________________________________________________________ $25
Not available with Short Back Height Range
Phone (800) 981-1540 | Fax (715) [email protected] | www.kimobility.com
DCN0013.28 Pricing and specifications subject to change without notice Page 1 of 12
HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions.
Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer’s coverage policy.
Seat Pan
q Removable Aluminum Seat Pan E2231 _____________________________________ $245Pan depth 1/2” shorter than Seat Depth
Effective 04/08/2019
Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________
Footrest
Hanger Bend
q 60º __________________________________________________________________________________________________________ N/CAvailable only with Extension Tube Hangers
q 70º __________________________________________________________________________________________________________ N/Cq 80º __________________________________________________________________________________________________________ N/C
Not available with 7” or 8” Casters
q 90º __________________________________________________________________________________________________________ N/CAvailable only with Front Mount Hangers. Not available with 7” or 8” Casters.
q Elevating Leg Rests (ELR) E0990 __________________________________________________ $295q Pro Elevating Leg Rests (PRO ELR) E0990 _______________________________ $350q Omit Hangers ___________________________________________________________________________________ - $20
Footplate
q Composite ____________________________________________________________________________________________ N/CNot available with Front Mount Hanger or PRO ELR
q Composite Angle Adjustable K0040 ___________________________________________ $185Not available with Front Mount Hanger, ELR or 14” Seat Width
q Aluminum Angle Adjustable K0040 _____________________________________________ $185q One Piece Flip Up Angle Adjustable K0040 ______________________________ $190
Not available with Front Mount Hanger, ELR or PRO ELR
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Backrest continued
Back Upholstery Military PatchAttached only if ordered with Tension Adjustable Back Upholstery
US Military Service Patch _______________________________________________________________________ $90q Army q Navy q Marines q Air Force q Coast Guard
q US Purple Heart Patch _____________________________________________________________________ $90
Purple Heart with Military Service Patch Combo __________________________ $145q Army q Navy q Marines q Air Force q Coast Guard
Footrest / Extension / Seat to Footrest LengthSelect Seat to Footrest Length in row corresponding to desired Footrest and Extension. Footrest Length of at least 2.5” shorter than Front Seat Height recommended. Extension Tube Hanger measurements are based on 70º Hanger / Front Frame Bend.
Footrest Extension Seat to Footrest Length
Extension TubeHangers(60º, 70º, 80º)
Short q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15
Medium q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17
Long q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5
Front Mount Hangers 1
Standard Selections Requires 3” Extension for $35
Short(70º, 80º, 90º)
q 5 q 5.5 q 6 q 6.5 q 7 q 10 q 10.5 q 11
q 7.5 q 8 q 8.5 q 9 q 9.5 q 11.5 q 12 q 12.5
Medium(70º, 80º, 90º)
q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 12 q 12.5 q 13
q 8.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5 q 13.5 q 14 q 14.5
Long(70º, 80º)
q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 8.5 q 9 q 14 q 14.5 q 15
q 9.5 q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 15.5 q 16 q 16.5
Elevating Leg Rests (ELR)
Short q 12 q 13 q 14 q 15 q 16
Long q 13 q 14 q 15 q 16 q 17 q 18
Extended Length ELR
Short q 18 q 19 q 20 q 21 q 22
Long q 18 q 19 q 20 q 21 q 22 q 23 q 24
PRO ELR Low Pivot Setting
Short q 12 - 17.5
Long q 15 - 21
PRO ELR High Pivot Setting
Short q 10.5 - 15.5
Long q 13 - 191 See Minimum Front Seat Height chart below.
Minimum Front Seat Height with Front Mount Hangers
Hanger Length Short Medium Long
Hanger Bend 70º 80/90º 70º 80/90º 70º 80º
Minimum Front Seat Height with Standard Selection
13.5” 13.5” 14” 15” 16” 17”
Minimum Front Seat Height with 3” Extension
14.5” 16” 16.5” 18” 18.5” 20”
3” ExtensionAvailable only with Front Mount Hangers. Provided as parts.
q 3” Extension for Front Mount Hanger __________________________________________ $35
q Standard ________________________________________________________________________________________________ StdNot available with Short or Medium Back Height Ranges on 20” - 22” Seat Widths
Tension Adjustable E2611
q Standard Cover _____________________________ $245 q Air Mesh Breathable Cover New! ______________ $320
q Omit Back Upholstery ___________________________________________________________________ - $10
DCN0013.28 Pricing and specifications subject to change without notice Page 2 of 12
Front Seat Height and Casters
Caster Type
q 1” Poly ___________________________________________________________________________________________________ N/Cq 1” Poly Aluminum _____________________________________________________________________________ $160
Available only with 4” and 5” Caster Sizes
q 1” Pneumatic _______________________________________________________________________________________ $85Available only with 6” and 8” Caster Sizes
q 1.5” Poly _______________________________________________________________________________________________ $50Not available with 7” and 8” Caster Sizes
q 1.5” Soft Roll Aluminum _________________________________________________________________ $175Not available with 7” and 8” Caster Sizes
q 2” Poly ___________________________________________________________________________________________________ $70Available only with 6” Caster Size
q 2” Pneumatic w/ Foam Insert ______________________________________________________ $225Available only with 8” Caster Size
Caster Size / Front Frame Type / Front Seat Height
Fork Options
Fork Stem
q Standard Fork Stem ___________________________________________________________________________ Stdq 3/4” Longer Fork Stem ____________________________________________________________________ $35q 1 1/2” Longer Fork Stem _________________________________________________________________ $35
q Frog Legs Ultra-Sport Fork - Black ____________________________________________ $425Available only with 4”, 5” or 6” Caster Sizes. Not available with Caster Pin Locks, Heavy Duty Option, 2” Poly caster or 2” Pneumatic w/ Foam Insert caster.
End User Weight Required: ____________ lbs
q Caster Pin Locks K0073 _________________________________________________________________ $195Not available with 1 1/2” Longer Fork Stem or Frog Legs Fork
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0013.28 Pricing and specifications subject to change without notice Page 3 of 12
Maximum Seat Dump Reference(Front Seat Height minus Rear Seat Height)
Seat Depth 14” 15” 16” 17” 18” 19” 20”
Maximum Dump 1.5” 2” 2” 2” 2.5” 2.5” 2.5”
Footrest continued
Heel LoopNot available with One Piece Flip Up Angle Adjustable Footplate
q Heel Loops E0951 ______________________________________________________________________________ $30q Adjustable Heel Loops E0951 ________________________________________________________ $50q Omit Heel Loops ________________________________________________________________________________ N/C
Residual Limb SupportResidual Limb Support E1020
q Left ____________________________ $395 q Right _____________________________ $395
q Omit Left Hanger ___- $10 q Omit Right Hanger ____ - $10
Cover q Smooth q Air Mesh q Smooth q Air Mesh
Pad Size q 5 x 8 q 9 x 14 q 5 x 8 q 9 x 14
q 7 x 10 q 11 x 10 q 7 x 10 q 11 x 10
q 9 x 10 q 11 x 14 q 9 x 10 q 11 x 14
Select Front Seat Height in row corresponding to desired caster size.Note: Selections in first three Front Seat Height columns use Super Low Front Frame.
Caster Size
Front Seat HeightUses Super Low Front Frame
4” q 13.51 q 14 q 14.5 q 152 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20
5” q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
6” q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 21
7” q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 21
8” q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 211 Front Seat Height not available with 4 x 1” Poly Caster2 Super Low Front Frame required when using 4 x 1” Poly Caster
Calf Strap
q Velcro Adjustable K0038 ___________________________________________________________________ $35q Padded Velcro Adjustable K0038 __________________________________________________ $68q Bodypoint Padded AeroMesh K0038 _________________________________________ $102
Hanger ReleaseIf no selection is made Classic Hanger Release will be used
q Classic ____________________________________________________________________________________________________ Stdq 4-Way - In line _____________________________________________________________________________________ N/C
See reference A to the right. Not available with ELR or PRO ELR.
q 4-Way - Out _________________________________________________________________________________________ N/CSee reference B to the right. Not available with ELR or PRO ELR.
A B
Rear Wheel Type
q Assembled 24” Six-Spoke Mag with Treaded Tireand Composite Handrim ______________________________________________________________ - $25
No substitutions available. Do not select Rear Tire Type or Handrim. Measures as Full Profile tire. Not available with Heavy Duty Option.
q 24” Spoke ____________________________________________________________________________________________ N/Cq Spoke (20”, 22”, 25” or 26”) _________________________________________________________ $100q MAXX Performance Spoke New! _____________________________________________ $150
Available only in 22” or 24” wheel sizes
q Mag ________________________________________________________________________________________________________ N/CNot available in 25” or 26” wheel sizes
q Superlight Spoke _____________________________________________________________________________ $295Available only in 24” and 25” wheel sizes. 25” wheel size available only with Superlight and Plastic Coated Handrims. Not available with Heavy Duty Option.
Spinergy Spox _________________________________________________________________________________________ $820Not available in 20” wheel size
Color: q Black q Red q White q Blue q Yellow
Handrim: q Short Tab q Long TabAvailable only with Aluminum Anodized and Plastic Coated Handrims
Rear Tire Type
q Street Pneumatic 1 3/8” E2211, E2212 ___________________________________________ StdNot available on 25” wheel size
q Full Poly 1 3/8” E2218 _______________________________________________________________________ N/CNot available on Superlight wheel or 25” or 26” wheel sizes
q Pneumatic with Airless Insert 1 3/8” E2211, E2213 ____________________ $95Not available on Superlight wheel or 25” wheel size
q Schwalbe HS-127 1 3/8” E2211, E2212 ______________________________________ $125Available only on 24” wheel size. Not available on Mag wheel.
q Euro Trek Knobby 1 3/8” E2211, E2212 __________________________________________ $95Available only on 24” wheel size
Handrim
Handrim Option
q 3M Micro Grip _____________________________________________________________________________________ $65Not available on Plastic Coated or Projection Handrims
q Low Poly 1” E2218 _____________________________________________________________________________ N/CNot available on Superlight wheel, 25” or 26” wheel sizes or Heavy Duty Option
q Sentinel Solid Tire 1” E2218 ____________________________________________________________ $95Not available on Superlight wheel or 20” and 22” Mag wheels
q High Pressure 1” E2211, E2212 ________________________________________________________ $95Not available on Mag wheel
Full Profile
Rear Seat Height and Wheels
Wheel Size / Tire Profile / Rear Seat Height
Low Profile
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
q Aluminum Anodized ___________________________________________________________________________ Stdq Superlight Aluminum Anodized _____________________________________________________ $50
Available only on 24” and 25” wheel sizes. Available only on MAXX Performance, Superlight or Spinergy wheels. Not available with Heavy Duty Option.
q Plastic Coated _____________________________________________________________________________________ $95q Projection (8 Vertical Projections) ________________________________________________ $295
Available only with full profile tires in combination with MAXX Performance, 22”-26” Spoke, or 24” Mag wheel
q Omit Handrim ______________________________________________________________________________________ N/C
Standard Handrims Not available on 20” wheel size or 22” Mag wheel. Not recommended with Mag wheel.
q Natural Fit LT Regular Grip ____________________________________________________________ $445q Natural Fit Standard Regular Grip _______________________________________________ $445q Natural Fit LT Super Grip _______________________________________________________________ $495q Natural Fit Standard Super Grip __________________________________________________ $495q Natural Fit LT Omit Grip _________________________________________________________________ $345q Natural Fit Standard Omit Grip ____________________________________________________ $345
Natural Fit Handrims
Select Rear Seat Height in row corresponding to desired Wheel Size and Tire Profile. 14” Seat Depth not available with 24”, 25” or 26” wheel sizes.
WheelSize
TireProfile
Rear Seat Height
20”Low q 12.51 q 13.5 q 14.5 q 15.5 q 16.5
Full q 131 q 14 q 15 q 16 q 17
22”Low q 13.51 q 14.5 q 15.5 q 16.5 q 17.5
Full q 141 q 15 q 16 q 17 q 18
24”Low q 14.51 q 15.5 q 16.5 q 17.5 q 18.5
Full q 151 q 16 q 17 q 18 q 19
25” Low q 151 q 16 q 17 q 18 q 19
26”Low q 15.51 q 16.5 q 17.5 q 18.5 q 19.5
Full q 161 q 17 q 18 q 19 q 201 Not available with Flip Back Armrests
DCN0013.28 Pricing and specifications subject to change without notice Page 4 of 12
Wheel Locks
Wheel Lock Wheel Lock Options
q Push to Lock ________________________________________________________________________________________ Stdq Push to Lock Flush Mount ______________________________________________________________ N/Cq Pull to Lock __________________________________________________________________________________________ N/Cq Omit Wheel Locks _____________________________________________________________________________ N/C
q Extension Handles E0961 ________________________________________________________________ $70Available only with Push to Lock or Pull to Lock Wheel Locks
q Grade Aids E0974 _____________________________________________________________________________ $150Available only with Push to Lock Wheel Locks and Pneumatic or Pneumatic with Airless Insert tires
Armrest Please select Arm Pad option
Removable Side Guard
q Height Adjustable T-Arm (8.5” - 13.5”) E0973 ________________________________ $265q Height Adjustable T-Arm Low (7.5” - 11.5”) E0973 ______________________ $265q Height Adjustable Flip Back T-Arm (9.5”-13.5”) E0973 _______________ $275q Flip Back (10.5”) ____________________________________________________________________________________ N/C
Not available with Seat Depths less than 16” or Angle Adjustable Back Posts
q Composite Side Guards K0108 ____________________________________________________ $140Not available with T-Arm or Flip Back Armrests
Accessories
Anti-Tip
q Rear Anti-Tips E0971 _______________________________________________________________________ $140
Positioning Belt
q 1 1/2” Auto Buckle E0978 ________________________________________________________________ $70q 1 1/2” Padded Auto Buckle E0978 _____________________________________________ $155q 2” Airline Buckle E0978 ___________________________________________________________________ $110
Bodypoint Evoflex - Pelvic Stabilizer E0978 ____________________________________ $183Size: q Small (16-24”) q Medium (19-29”) q Large (25-37”)
Bodypoint Belt Mounting Kit _______________________________________________________________ $105Style: q Bracket q Band Clamp 1”
Other Accessories
q Tool Kit ___________________________________________________________________________________________________ $45q Removable Underseat Pouch ________________________________________________________ $50q Ki Mobility Backpack ________________________________________________________________________ $65q Black Neoprene Impact Guards ____________________________________________________ $85q Clear Spoke Guards K0065 ___________________________________________________________ $115
Not available with Mag wheel
q Black Spoke Guards K0065 __________________________________________________________ $115Not available with 20” wheel size or Mag wheel
q Cane and Crutch Holder _______________________________________________________________ $195q IV Pole _________________________________________________________________________________________________ $265
Available only with Standard Straight Back Posts
Frame Color
Matte FinishGloss Finish
q Army Green __________________________________________________________________________________________ N/Cq Charcoal Gray _____________________________________________________________________________________ N/Cq Emerald Green ____________________________________________________________________________________ N/Cq Iridescent Burgundy __________________________________________________________________________ N/Cq Iridescent Navy ___________________________________________________________________________________ N/Cq Retro Red _____________________________________________________________________________________________ N/Cq Royal Blue ____________________________________________________________________________________________ N/Cq Shadow Black _____________________________________________________________________________________ N/Cq Smooth White _____________________________________________________________________________________ N/C
q Black ______________________________________________________________________________________________________ N/Cq Blue Skies ____________________________________________________________________________________________ N/Cq Bubblegum Pink _________________________________________________________________________________ N/Cq Candy Blue __________________________________________________________________________________________ N/Cq Candy Purple ______________________________________________________________________________________ N/Cq Candy Red ___________________________________________________________________________________________ N/Cq Copper __________________________________________________________________________________________________ N/Cq Granny Smith ______________________________________________________________________________________ N/Cq Metallic Fuchsia New! ____________________________________________________________________ N/Cq Metallic Orange __________________________________________________________________________________ N/Cq Yellow ____________________________________________________________________________________________________ N/C Hydrographics
Visit www.kimobility.com for current Hydrographics options. Note selection below
q $695
q Swing Away (10.5” - 12.5”) E0973 _____________________________________________________ $195Not available with Angle Adjustable Back Posts or Arm Pads
q Omit Armrests _____________________________________________________________________________________ N/C
Arm Pad
Armrests
Armrest continued
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0013.28 Pricing and specifications subject to change without notice Page 5 of 12
O2 HolderO2 Holder E2208 ______________________________________________________________________________________ $295 q Right Side q Left Side
Not available with Swing Away Armrests
Standard Arm Pad __________ N/C q Desk q Full
Waterfall Arm Pad ____________ $25 q Desk q FullAvailable only with Height Adjustable T-Arm and Height Adjustable T-Arm Low
Axle
q Quick Release ______________________________________________________________________________________ Stdq Quad Quick Release _______________________________________________________________________ $195
Not available with Mag or Spinergy wheels
Axles
Axle Bracket
q Offset Axle Bracket _____________________________________________________________________________ Stdq Reverse Mount Offset Axle Bracket _____________________________________________ N/C
Not available with Swing Away Armrests
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0013.28 Pricing and specifications subject to change without notice Page 6 of 12
Catalyst Front Seat Height Matrix
4” Caster 5” Caster 6” Caster 7” Caster 8” Caster
FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork
151 13.51
Std
4”
16 14.5 Std
4”
17 15.5 Std
5”
18 17Std
6”
19 18 Std
6”15.5 14 16.5 15.5 3/4 18 16.5 3/4 18.5 17.5 20 18.5 3/4
162 14.52
3/417.5 16 1 1/2 18.5 17 1 1/2 19 17.5
3/420.5 n/a 1 1/2
16.5 15 16 15Std
5”
17 16
Std
6”
19.5 18 19 17.5
Std
7”
16.52 152
1 1/216.5 15.5 17.5 16.5 19.5 18.5
1 1/219.5 18
17 15.5 17 15.53/4
18 17 20 19 20 18.5
15.5 14.5Std
5”
17.5 16 18 16.5
3/4
18.5 17.5
Std
7”
20.5 19
16 15 17.5 16.51 1/2
18.5 17 19 18 19.5 18.5
3/416.5 15
3/418 17 19 17.5 19.5 18.5 20 19
17 15.5 16.5 15.5
Std
6”
18.5 17.5
1 1/2
20 19 20.5 n/a
17 161 1/2
17 16 19 18 19 18
3/4
21 n/a
17.5 16.5 17.5 16.5 19.5 18.5 19.5 18.5 20.5 191 1/2
17 15.5Std
6”
17.5 16
3/4
18 16.5
Std
7”
20 19 21 n/a
17.5 16 18 16.5 18.5 17 20.5 n/a 8” x 2” caster not available with 6” fork17.5 16.5
3/418.5 17 19 17.5 20 18.5
1 1/218 17 18 17
1 1/2
19.5 18.5 20.5 19
18.5 171 1/2
18.5 17.5 18.5 17.5
3/4
21 n/a
19 17.5 19 18 19 18
18 17Std
7”
18 16.5
Std
7”
19.5 18.5
18.5 17.5 18.5 17 20 19
19 17.53/4
19 17.5 19.5 18
1 1/219.5 18 18.5 17.5
3/4
20 18.5
19.5 18.51 1/2
19 18 20.5 19
20 19 19.5 18.5 21 n/a
19.5 18
1 1/2
6” x 2” caster not available with 5” fork
20 18.5
20.5 19
1 Front Seat Height not available with 4 x 1” Poly Caster 2 Not available with 4 x 1” Poly, 4 x 1.5” Poly or 4 x 1.5” Soft Roll Aluminum
Seat heights with “FSH” heading available with Standard Front Frame. Seat heights with “Super Low” heading available with Super Low Front Frame. Actual seat height may vary depending upon configuration.
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0013.28 Pricing and specifications subject to change without notice Page 7 of 12
Axiom G, S and P Cushions
Cushions Under 22” WideWidth
14” 15” 16” 17” 18” 19” 20” 21” 22”
Dep
th
14” q15” q q q16” q q q q q q q17” q q q q q q18” q q q q q q q19” q q q20” q q q q q
q Axiom G E2601 __________________________________________________________________________________ $120q Axiom S E2603 __________________________________________________________________________________ $199q Axiom P E2605 __________________________________________________________________________________ $340
q Axiom G E2602 __________________________________________________________________________________ $199q Axiom S E2604 __________________________________________________________________________________ $299q Axiom P E2606 __________________________________________________________________________________ $440
q Axiom SP - Visco E2607 _________________________________________________________________ $410q Axiom SP - Fluid E2607 __________________________________________________________________ $449
q Axiom SP - Visco E2608 _________________________________________________________________ $499q Axiom SP - Fluid E2608 __________________________________________________________________ $549
Width
14” 15” 16” 17” 18” 19” 20” 21” 22”
Dep
th
14” q q q15” q q q q q16” q q q q q q q q17” q q q q q q q q18” q q q q q q q q q19” q q q q q q q q20” q q q q q q q q
Outer Covers
q Axiom G Extra Outer Cover ____________________________________________________________ $70q Axiom S Extra Outer Cover _____________________________________________________________ $80q Axiom P Extra Outer Cover _____________________________________________________________ $90q Axiom SP Extra Visco Outer Cover ____________________________________________ $100q Axiom SP Extra Fluid Outer Cover _____________________________________________ $100
q Axiom SP Extra Visco Inner Cover _____________________________________________ $100q Axiom SP Extra Fluid Inner Cover _______________________________________________ $100
22” Wide Cushions
Axiom SP Cushions
Cushions Under 22” Wide
22” Wide Cushions
Axiom Cushion Accessories
Select size in chart below. Weight capacity: 350 lbs.
Solid Seat Insert ________________________________________________________________________________________ $55
Solid Seat Insert
Inner Covers
Width
14” 15” 16” 17” 18” 19” 20” 21” 22”
Dep
th
14” q15” q q q16” q q q q q q q17” q q q q q q18” q q q q q q q19” q q q20” q q q q qInner Cover Quantity: q 1 q 2
If no selection is made, quantity 1 will be selected
Outer Cover Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Solid Seat Insert Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Axiom SP Cushion Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Axiom G, S or P Cushion Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Select size in chart at right. Weight capacity: 350 lbs.
Select size in chart at right. Weight capacity: 350 lbs.
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0013.28 Pricing and specifications subject to change without notice Page 8 of 12
New!Axiom Back Hardware is included with back. Low Back selections are not available with headrests. Weight capacity: 300 lbs.
Width
12” 14” 16” 18” 20” 22”Retail $555 $555 $555 $555 $555 $791
HCPC E2613 E2613 E2613 E2613 E2613 E2614
Hei
gh
t Lo
w
8” q AXPB1208 q AXPB1408 q AXPB1608 q AXPB1808 q AXPB2008
10” q AXPB1410 q AXPB1610 q AXPB1810 q AXPB2010 q AXPB2210
12” q AXPB1212 q AXPB1412 q AXPB1612 q AXPB1812 q AXPB2012
Mid
14” q AXPB1414 q AXPB1614 q AXPB1814 q AXPB2014 q AXPB2214
16” q AXPB1216 q AXPB1416 q AXPB1616 q AXPB1816 q AXPB2016
18” q AXPB1418 q AXPB1618 q AXPB1818 q AXPB2018 q AXPB2218
Axiom Posterior Back (PB)
Width
12” 14” 16” 18” 20” 22”Retail $636 $636 $636 $636 $636 $862
HCPC E2615 E2615 E2615 E2615 E2615 E2616
Hei
gh
t
Lo
w
8” q AXPL1208 q AXPL1408 q AXPL1608 q AXPL1808 q AXPL2008
10” q AXPL1410 q AXPL1610 q AXPL1810 q AXPL2010 q AXPL2210
12” q AXPL1212 q AXPL1412 q AXPL1612 q AXPL1812 q AXPL2012
Mid
14” q AXPL1414 q AXPL1614 q AXPL1814 q AXPL2014 q AXPL2214
16” q AXPL1216 q AXPL1416 q AXPL1616 q AXPL1816 q AXPL2016
18” q AXPL1418 q AXPL1618 q AXPL1818 q AXPL2018 q AXPL2218
Tall 20” q AXPL1220 q AXPL1420 q AXPL1620 q AXPL1820 q AXPL2020
22” q AXPL1422 q AXPL1622 q AXPL1822 q AXPL2022 q AXPL2222
Axiom Posterior Lateral Back (PL)
Axiom Posterior Back - Low Axiom Posterior Back - Mid
Axiom Posterior Back Measurement Reference
Back Height A B Shell Contour Depth
Hei
gh
t Lo
w
8” 10” 6.5”
2.25”
10” 12” 8.5”
12” 14” 10.5”
Mid
14” 16” 8.5”
16” 18” 9.5”
18” 20” 10.5”
A
4.1
BA
4.1
B
Axiom Posterior Lateral Back Measurement Reference
Back Height A B Shell Contour Depth
Hei
gh
t
Lo
w
8” 10” 6.5”
3.65”
10” 12” 8.5”
12” 14” 10.5”
Mid
14” 16” 8.5”
16” 18” 9.5”
18” 20” 10.5”
Tall 20” 22” 11.5”
22” 24” 12.5”Axiom Posterior Lateral
Back - LowAxiom Posterior Lateral
Back - MidAxiom Posterior Lateral
Back - Tall
A
5.5
B
5.5
AB
A
5.5
B
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0013.28 Pricing and specifications subject to change without notice Page 9 of 12
Width
12” 14” 16” 18” 20” 22”Retail $735 $735 $735 $735 $735 $813
HCPC E2620 E2620 E2620 E2620 E2620 E2621
Hei
gh
t
Lo
w
8” q AXLB1208 q AXLB1408 q AXLB1608 q AXLB1808 q AXLB2008
10” q AXLB1410 q AXLB1610 q AXLB1810 q AXLB2010 q AXLB2210
12” q AXLB1212 q AXLB1412 q AXLB1612 q AXLB1812 q AXLB2012
Mid
14” q AXLB1414 q AXLB1614 q AXLB1814 q AXLB2014 q AXLB2214
16” q AXLB1216 q AXLB1416 q AXLB1616 q AXLB1816 q AXLB2016
18” q AXLB1418 q AXLB1618 q AXLB1818 q AXLB2018 q AXLB2218
Tall 20” q AXLB1220 q AXLB1420 q AXLB1620 q AXLB1820 q AXLB2020
22” q AXLB1422 q AXLB1622 q AXLB1822 q AXLB2022 q AXLB2222
Axiom Lateral Back (LB)
Axiom Back continued Hardware is included with back. Low Back selections are not available with headrests. Weight capacity: 300 lbs.
Axiom Lateral Back Measurement Reference
Back Height A B Shell Contour Depth
Hei
gh
t
Lo
w
8” 10” 6.5”
3.65”
10” 12” 8.5”
12” 14” 10.5”
Mid
14” 16” 8.5”
16” 18” 9.5”
18” 20” 10.5”
Tall 20” 22” 11.5”
22” 24” 12.5”Axiom Lateral
Back - LowAxiom Lateral
Back - MidAxiom Lateral
Back - Tall
A
5.5
B
5.5
AB
A
5.5
B
Axiom Deep Lateral Back (DL)
Width
12” 14” 16” 18” 20” 22”Retail $735 $735 $735 $735 $735 $813
HCPC E2620 E2620 E2620 E2620 E2620 E2621
Hei
gh
t
Mid
14” q AXDL1214 q AXDL1414 q AXDL1614 q AXDL1814 q AXDL2014 q AXDL2214
16” q AXDL1416 q AXDL1616 q AXDL1816 q AXDL2016
18” q AXDL1218 q AXDL1418 q AXDL1618 q AXDL1818 q AXDL2018 q AXDL2218
Tall 20” q AXDL1220 q AXDL1420 q AXDL1620 q AXDL1820 q AXDL2020
22” q AXDL1422 q AXDL1622 q AXDL1822 q AXDL2022 q AXDL2222
Axiom Deep Lateral Back Measurement Reference
Back Height A
B1 Shell Contour Depth12” 14” 16” 18” 20” 22”
Hei
gh
t
Mid
14” 16” 8.25” 8.25” 8.25” 8.25” 8.25” 8.25”
6”
16” 18” 9.25” 9.25” 9.25” 9.25” 9.25” 9.25”
18” 20” 10.25” 10.25” 10.25” 10.25” 10.25” 10.25”
Tall 20” 22” 9.5” 9.75” 10” 10.25” 10.25” 10.5”
22” 24” 10.75” 11” 11.25” 11.5” 11.5” 11.75”1 Measurement based on back width
Axiom Deep Lateral Back - Mid Axiom Deep Lateral Back - Tall
AB
7.75
AB
7.75
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0013.28 Pricing and specifications subject to change without notice Page 10 of 12
Axiom Back Accessories
Headrest and Hardware
HMO400 HMO475-1 TWB480-1
CP450
CP250
CP150
AP250
AP350
AP450
TCP205
TCP105
Choose headrest and hardware combination in chart below. Available only on Mid or Tall
Hardware
Standard Straight Back Mount Hardware with 1” Ball
Multi Axis Removable Hardware with 1” Horizontal Bar
Headrest Hardware with 1” Ball
HMO400 HMO475-1 TWB480-1Description Item Code HCPC Kio Code Retail Kio Code Retail Kio Code Retail
Hea
dre
st P
ad
Comfort Plus Headrest 8” CP450 E0955 q HDR001 $277 q HDR009 $313 q HDR017 $388
Comfort Plus Headrest 10” CP250 E0955 q HDR002 $277 q HDR010 $313 q HDR018 $388
Comfort Plus Headrest 14” CP150 E0955 q HDR003 $277 q HDR011 $313 q HDR019 $388
Small All Positioning Headrest Pad and Ring Only
AP250 E0955 q HDR004 $277 q HDR012 $313 q HDR020 $388
Medium All Positioning Headrest Pad and Ring Only
AP350 E0955 q HDR005 $277 q HDR013 $313 q HDR021 $388
Large All Positioning Headrest Pad and Ring Only
AP450 E0955 q HDR006 $277 q HDR014 $313 q HDR022 $388
Tri-Comfort Plus Headrest 14” TCP205 E0955 q HDR007 $288 q HDR015 $324 q HDR023 $399
Tri-Comfort Plus Headrest 19” TCP105 E0955 q HDR008 $288 q HDR016 $324 q HDR024 $399
For use with other manufacturer headrests
Description Item Code HCPC Retail
q Universal Mounting Plate UMP K0108 $40
Universal Mounting Hardware
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0013.28 Pricing and specifications subject to change without notice Page 11 of 12
Axiom Back Accessories continued
Available only with Axiom Lateral Back and Axiom Deep Lateral back
Description Item Code HCPC Retail
q Lumbar Pad 12” L12 K0108 $48
q Lumbar Pad 14” L14 K0108 $48
q Lumbar Pad 16” L16 K0108 $48
q Lumbar Pad 18” L18 K0108 $48
q Lumbar Pad 20” L20 K0108 $48
q Lumbar Pad 22” L22 K0108 $48
Lumbar Pads
Description Item Code HCPC Retail
q Privacy Flap 12” PF12 K0108 $45
q Privacy Flap 14” PF14 K0108 $45
q Privacy Flap 16” PF16 K0108 $45
q Privacy Flap 18” PF18 K0108 $45
q Privacy Flap 20” PF20 K0108 $45
q Privacy Flap 22” PF22 K0108 $45
Privacy Flap
Lateral SupportSold in pairs
Description Item Code HCPC Retail
Laterals for Posterior Back
q 3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF3x4P E0956 $305
q 4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF4x5P E0956 $305
q3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back
LS3x4P E0956, E1028 $650
q4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back
LS4x5P E0956, E1028 $650
Laterals for Posterior Lateral Back and Lateral Back
q3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral and Axiom Lateral Backs
LF3x4L E0956 $305
q4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral and Axiom Lateral Backs
LF4x5L E0956 $305
q3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral and Axiom Lateral Backs
LS3x4L E0956, E1028 $650
q4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral and Axiom Lateral Backs
LS4x5L E0956, E1028 $650
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0013.28 Pricing and specifications subject to change without notice Page 12 of 12
Axiom Back Accessories continued
Description Item Code HCPC Retail
q Small Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60153T E0960 $144
q Medium Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60154T E0960 $144
q Large Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60155T E0960 $144
q Small Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60110T E0960 $113
q Medium Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60111T E0960 $113
q Large Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60112T E0960 $113
q Small Dynamic Therafit Comfortfit Full Vest 30589T E0960 $167
q Medum Dynamic Therafit Comfortfit Full Vest 30590T E0960 $167
q Large Dynamic Therafit Comfortfit Full Vest 30591T E0960 $167
q XLarge Dynamic Therafit Comfortfit Full Vest 30592T E0960 $167
q XXLarge Dynamic Therafit Comfortfit Full Vest 30593T E0960 $167
q Small Dynamic Therafit Comfortfit Trim Vest 30618T E0960 $169
q Medum Dynamic Therafit Comfortfit Trim Vest 30619T E0960 $169
q Large Dynamic Therafit Comfortfit Trim Vest 30620T E0960 $169
q XLarge Dynamic Therafit Comfortfit Trim Vest 30621T E0960 $169
q XXLarge Dynamic Therafit Comfortfit Trim Vest 30622T E0960 $169
Therafin Posture Support
Description Item Code HCPC Retail
q Modification for 4 Point Harness AXM4PT K0108 N/C
q Modification for 2 Point Chest Strap AXM2PT K0108 N/C
q Modification for Shoulder GuidesIncludes shoulder guides
AXMSG K0108 $50
Axiom Back Modifications
Gloss Finish Item Code Retail
q Black AXMBLK N/C
q Blue Skies AXMSKY N/C
q Bubblegum Pink AXMPNK N/C
q Candy Blue AXMCBL N/C
q Candy Purple AXMPUR N/C
q Candy Red AXMRED N/C
q Copper AXMCOP N/C
q Granny Smith AXMGSM N/C
q Metallic Fuchsia AXMMTF N/C
q Metallic Orange AXMMOR N/C
q Yellow AXMYLW N/C
Painted Back Shell Modification
Matte Finish Item Code Retail
q Army Green AXMAGM N/C
q Charcoal Gray AXMCGM N/C
q Emerald Green AXMEGM N/C
q Iridescent Burgundy AXMIBM N/C
q Iridescent Navy AXMINM N/C
q Retro Red AXMRRM N/C
q Royal Blue AXMRBM N/C
q Smooth White AXMSWM N/C
If no selection is made, standard Shadow Black will be used with no additional lead time
Axiom Back Modifications Extended lead times will apply for all modifications