Rival Order Form with Contoured, Synergy, and TRU-Balance ... · Rival® Order Form with Contoured, Synergy, and TRU-Balance Flex Seating ... Please see cross-reference spreadsheet

Page 1 of 16INFINFB3914/RevB/01MAY2018

Rival® Order Form with Contoured, Synergy, and TRU-Balance Flex Seating

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. Options noted with "XRef" have multiple possible part numbers based on system configuration. Please see cross-reference spreadsheet for the XRef part numbers.

Thank you for choosing Quantum!

INTRODUCTION

PATIENT INFORMATION

1. BASE MODELREQUIRED. Select a group 3 power base. 300 lb. weight capacity with standard 6 mph programmable motors and 8 amp off board charger. Dimensions of base without legrests: 25”Wx36”L.

Quantum Rival 3S-SS ...................................................$6,608Part: QRIVAL 3S-SS. HCPCS: K0848Solid seat pan standard with no power option.

Quantum Rival 3S-C ....................................................$6,608Part: QRIVAL 3S-C. HCPCS: K0849Contoured Seat (Captain) Standard.

https://get.adobe.com/reader/

http://www.quantumrehab.com/resources/downloadorderforms.php?f=seating/us_physical_assessment_form.pdf


9" Pneumatic ....................... StandardPart: FRMASMB17634

9" Flat Free .............................. $105Part: FRMASMB17635

8" Flat Free .............................. $105Part: MEC141453

Lowest HeightPart: PTOINDV3558

Medium HeightPart: PTOINDV3559

Highest HeightPart: PTOINDV3560

3”x14” Flat Free Black Tires ...................................... StandardPart: WHLASMB2246 x2

4”x14” Knobby, Flat Free Black Tires ....................... $275.50 ea.Extended Traction TiresPart: WHL122174 x2

3”x14” Pneumatic Black Tires .................................. No ChargePart: WHLASMB2247 x2

4”x14” Knobby, Pneumatic Black Tires ..................... $275.50 ea.Extended Traction TiresPart: WHL122175 x2

6 mph Drive Motors ................................................. StandardPart: MOT132462

6 mph, Accu-Trac Motor ............................................... $1,295Part: MOT134093. HCPCS: K0108Requires Q-Logic 2 electronics. Delivers enhanced traction and track-ing, especially with switched drive controls.

8 mph Song Motors ..................................................... $1,574Part: MOT132468Not available with NE 4 Key Joystick

Community Use Package .............................................. $2,125Part: PTOINDV3262Package Includes 8 mph Song Motors and 4"x14" Knobby, Flat Free or Pneumatic tires. Increases overall base width by 1.5".

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: DGN153201-PRD1

Electric BluePart: DGN153201-PBU9

Back in BlackPart: DGN153201-PBK1

White SatinPart: DGN153201-PWT2

Pretty in PinkPart: DGN153201-PPK3

Deep PurplePart: DGN153201-PPR5

Lime LightPart: DGN153201-PGN7

Grey Street Part: DGN153201-PSL3

Silver BulletPart: DGN153201-PSL7

Midnight BluePart: DGN153201-PBU10

Orange CrushPart: DGN153201-POR6

Yellow BlazePart: DGN153201-PYL3

To Be DeterminedPart: N/A

3. DRIVE MOTORSREQUIRED.

6. SUSPENSIONREQUIRED.

8. CONTOURED SEAT, SEAT TO FLOOR HEIGHTREQUIRED with contoured seating.

7. FULL LIGHT PACKAGEOptional. Requires NE+ 8 Key or Q-Logic 2 Joystick for Full Light Package.

5. FRONT CASTER WHEELSREQUIRED. For optimal ride quality, pneumatic casters are recommended.




White SatinPart: DGN164245-PWH2




Grey StreetPart: DGN164245-PSL3





To Be DeterminedFollow-up required.

4. DRIVE WHEELSREQUIRED. Select a type of drive wheels. Knobby tires increase overall base width by 1.5”.

Match to Base Color ............................................... $24.98 ea.Part: Configuration selection, see specific part below

Non-matching Color ............................................... $24.98 ea.Part: Configuration selection, see specific part below

Drive Wheel Accent Color Optional. Not available with knobby tires. Select with WHL1703421 above. Sold in Pairs (parts below will be quantity of 2).

Standard Suspension ................................................ StandardPart: PTOINDV3545

Heavy Suspension .................................................. No ChargePart: MEC120220

Base Mounted, LED, Light Package.....................................................................................................................................$995Part ELEASMB7431

NE+ 6 Key Joystick

NE 4-Key Joystick ....................................StandardPart: CTLDC1554Does not control actuators.

NE+ 6-Key Joystick .......................................$200Part: CTLDC1560Control up to 2 actuators through joystick.

NE+ 8-Key Joystick (2 Actuators) ......................$400Part: CTLDC1561Control up to 2 actuators and Full Light Package through joystick.

No Joystick, Setup for NE+ Joystick ...........No ChargePart: Configuration selection

9. 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.

9.1a. Non-Expandable ControlsSelect a joystick below or omit selection if another controller type is desired. Non-expandable does not allow supplementary drive controllers.

Electronics section continued on following page.

http://www.quantumrehab.com/resources/downloadorderforms.php?f=electronics/us_alternative_controls_order_form.pdf


3. Q-Logic 2 Joystick ShroudREQUIRED with Q-Logic 2 EX Joystick selection above. Reference colors shown on page 2.

2. Q-Logic 2 Joystick

1. 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.

Account Number: ___________ Date: ________________ Marked for: _____________________________________

Stand Alone Joystick

Q-Logic 2 EX Joystickwith Lime Light

Q-Logic 2 EXController Module

9. ELECTRONICS continued9.1b. 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.

9.2. SCIM ModuleOptional.

SCIM Module Kit for Q-Logic 2......................................................................................................... $525Part: CTL168055Available with Q-Logic 2 EX Joystick selection above. Allows use of joystick display for specialty devices and offers 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

Black, Soft Touch ....................................StandardPart: DGN124307

Non-matching Joystick Shroud.......................... $50Part: PTOINDV3422Select color below

Match Joystick Shroud to Base Color .................. $50Part: PTOINDV3421













Q-Logic 2 EX Controller Module .......................$695Part: See XRef. HCPCS: E2377

Q-Logic 2 Expandable Controller Harness ...........$425Part: DWR1111H065. HCPCS: E2313

Q-Logic 2 EX Joystick ....................................$700Part: CTL123217

Q-Logic 2 EX Joystick for Full Lights .................$700Part: CTL124653

No Joystick, Setup for Q-LogicPart: Configuration selection.

Stand Alone Joystick with ..............................$700External Charger PortPart: ELEASMB5205Up to 3 drive profiles and 1 seating profile when used alone. Use in conjunction with Enhanced Display for up to 5 profiles and auxiliary functions such as Bluetooth Mouse and IR. Includes charger port mounting bracket and multiplier box harness.

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

Joystick Handles

11.1a. Fixed, In-line Joystick Bracket

10. JOYSTICK HANDLESREQUIRED. The NE Plus and Q-Logic 2 EX Joysticks are standard with a carrot handle (See A in image). The optional handle will be mounted to the joystick and the standard handle will be shipped with the unit.

11. JOYSTICK MOUNTING BRACKETSOptional. Select a mount to be used with a joystick selected in previous section.

Omit Joystick Mounting Bracket

Fixed, In-line, Bracket .............................................. StandardQ-Logic Part: FRMASMB10617. NE/NE+ Part: FRMASMB12744

Left Side MountPart: PTOINDV1225

Right Side MountPart: PTOINDV1226

Joystick mounting brackets continued on following page.

Swing-Away (Retractable) (right side)

InlineStyle

OffsetStyle



11.1b. Swing-Away (Retractable) Joystick BracketAllows the joystick to retract to the side of the armrest while maintaining the same joystick orientation. "Inline bracket" will be offset 1" when used with tube style arms. Select "Offset Bracket" to have the joystick inline with armpad on tube style armrests.

11. JOYSTICK MOUNTING BRACKETS continued

Q-Logic EX/NE Programmer ............................................ $545Part: ELEASMB6976

Q-Logic PC Programming Disk with Cable ........................... $750Part: ELEASMB5216

12. ELECTRONICS ACCESSORIESOptional.

Multi-Axis JoystickMount

Retract4

Swing-Away/Flip DownBracket (Stand Alone

Hardware Shown)

16”Wx16”D ....................... No ChargePart: SETASMB3178





18”Wx20”D....................... No ChargePart: SETASMB3182



20”Wx20”D ...................... No ChargePart: SETASMB3185







13. CONTOURED SEATINGOptional. Select only one seating system. Special order seat sizes can be requested by checking the seat type and writing in the seat size in the special order seat size.

18”Wx18”-20”D with 60" Lap Belt ............................. No ChargePart: SETASMB6895



13.1a. Captain Style Seating

13.1b. Contoured Seat with Solid Seat Pan

1a. Depth Adjustable High Back with Limited Recline Full length armrests must be selected with a depth adjustable high back.

1b. High Back with Limited Recline

1c. Medium Back

1a. High Back with Limited Recline and Solid Seat Pan

16”Wx16”D .......... No ChargePart: SETASMB2488




Contoured seating section continued on following page.





13.1c. Special Order Contoured SeatComplete information below. Contact inside sales specialist for pricing.

1b. Medium Back with Solid Seat Pan

Depth:______Width:______Type of Seat:____________________________________________________

11.1c. Specialty Joystick MountsSelect a bracket and side to mount it.

Specialty Mount SideLeft Side MountPart: PTOINDV1225

Right Side MountPart: PTOINDV1226

Retract4 Mount ............................................$350NE/NE+ Part: MEC138876. HCPCS: E1028Q-Logic Part: MEC138860. 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 ..........................................$100NE/NE+ Part: ACC142528. HCPCS: E1028Q-Logic Part: ACC131216. HCPCS: E1028Stand Alone Part: ACC142740. HCPCS: E1028Allows height adjustment of joystick.

Stealth Swing-Away/Flip Down Bracket ..........$294.25NE/NE+ Part: ST-TWBM480QL-Q. HCPCS: E1028Q-Logic Part: ST-TWBM480QL-Q. HCPCS: E1028Stand Alone Part: ST-TWBM480CJ-Q. HCPCS: E1028Allows the joystick to pivot to side of armrest,or flip-down if bracket is adjusted.

Swing-away, Inline, Left Side Mount ..................$245Part: See XRef. HCPCS: E1028

Swing-away, Inline, Right Side Mount ................$245Part: See XRef. HCPCS: E1028

Swing-away, 1” Offset, Left Side Mount .............$245Part: See XRef. HCPCS: E1028

Swing-away, 1” Offset, Right Side Mount ............$245Part: See XRef. HCPCS: E1028



13. CONTOURED SEATING continued13.2. Contoured Seat Flip-Up, Height Adjustable, Removable ArmrestsREQUIRED with High Back Seat except with Depth Adjustable High Back. Select a Left and Right Armrest or to Omit them.

Full Length, Left Armrest .................................................$85Part: FRMASMB8614. HCPCS: E0973

Desk Length, Left Armrest ................................................$85Part: FRMASMB8612. HCPCS: E0973

No Armrest ............................................................ StandardPart: N/A

Full Length, Right Armrest ................................................$85Part: FRMASMB8615. HCPCS: E0973

Desk Length, Right Armrest ..............................................$85Part: FRMASMB8613. HCPCS: E0973

14. SYNERGY SEATING SYSTEMOptional. Widths, depths, and heights are available in 1" increments in the noted ranges. Maximum seat size 22"W x 22"D.

14.1. Synergy Frame Selection

14.3. Seat Dimension - Width PackageREQUIRED with Synergy seating. Maximum seat width is 22".

Synergy Seating System ................................................................................................................................................. $434Part: PTOINDV2995

10”-14” Width PackagePart: FRMASMB18011




14.2. Seat Dimension - WidthREQUIRED with Synergy seating. Maximum seat width is 22". Part number is SETWDTH plus number following # below.

12” W(#1002)

13” W(#1003)

14” W(#1004)

15” W(#1005)

16” W(#1006)

17” W(#1007)

18” W(#1008)

19” W(#1009)

20” W(#1010)

21” W(#1011)

22” W(#1012)

10”-14” Depth PackagePart: FRMASMB6981




14.5. Seat Dimension - Depth PackageREQUIRED with Synergy seating. Maximum seat depth is 22".

14.6. Synergy Back OptionsREQUIRED with Synergy seating. See the Synergy 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.

14.4. Seat Dimension - DepthREQUIRED with Synergy seating. Maximum seat depth is 22". Part number is SETDPTH plus number following # below.

12” D(#1002)

13” D(#1003)

14” D(#1004)

15” D(#1005)

16” D(#1006)

17” D(#1007)

18” D(#1008)

19” D(#1009)

20” D(#1010)

21” D(#1011)

22” D(#1012)

Synergy Back Cushion .................................................... $275Part: See XRefSelect a back cane type and height and back height.

TRU-Comfort, 20” Width or less....................................... $675Part: See XRef. HCPCS: E2620Select back height.

TRU-Comfort, 22” Width or greater .................................. $775Part: See XRef. HCPCS: E2621Select back height.

Sling Back .....................................................................$98Part: See XRefSelect a back height. Back cane height must match back height. Not available with flip up cantilever arms.

Omit Back ............................................................ No ChargePart: PTOINDV1287Select a back cane type and height in following section.

1. Back Selection

Synergy seating section continued on following page.

Synergy Back Cane ................................................ No ChargePart: FRMASMB15844Select a back cane height.

Flip Forward Back Cane ................................................. $150Part: FRMASMB15846Select a back cane height. Not available with oxygen holder, or cane mounted and cantilever armrests.

2” Mesomorph (1” per side) Back Cane ...............................$195Part: FRMASMB12067Select a cane height.


2” Endomorph (1” per side) Back Cane ...............................$195Part: FRMASMB12115Select a cane height.


Manual Recline Back ..................................................... $750Part: FRMASMB12910. HCPCS: E1226Select an overall back height. Back canes will be 22” H. Not available with flip back armrests, cantilever armrests, TRU-Comfort Back, rear accessories, or articulating foot platform.

2. Back Cane Selection

Width

Synergy and TRU-Comfort Back Availability Chart

Synergy Back Synergy or TRU-Comfort Back

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14. SYNERGY SEATING SYSTEM continued

3. Synergy Push Handles

4. Synergy Accessory Bar

6. Synergy Back Cane HeightOmit this selection if a TRU-Comfort back is selected. 16" and 17" back canes are not available with a Synergy Back and cane mounted, flip up armrests. 14" and 15" back canes are not available without push handles. Parts: See XRef, configuration selection with push handles selection.

5. Synergy Overall Back HeightRefer to the Synergy and TRU-Comfort back availability chart for stock order back size ranges. Parts: See XRef, configuration selection with back selection.

Accessory Bar ...............................................................................................................................................................$10012"W-16"W Part: MEC145955. 16"W-20"W Part: MEC143975

Push Handles .......................................................... StandardPart: Configuration selection with back cane height

Omit Push Handles .........................................................$125Part: Configuration selection with back cane heightNot available with Sling Back. Minimum cane height is 16".

14” High Canes15” High Canes16” High Canes




12” High Back13” High Back14” High Back




24” High Back25” High Back

14.6. Synergy Back Options continued

1a. Flip Back, Cane Mounted ArmrestsMay interfere with swing-away laterals.

1b. Two-Post, Flip Back, Height Adjustable, Removable ArmrestsNot available with a depth less than 16". Required with flip forward back and laptrays.

1c. Single-Post, Heavy Duty, 8"-12" Height Adjustable, Removable Armrests

1d. Single-Post, Heavy Duty, 10"-14" Height Adjustable, Removable Armrests

1e. Pediatric, Removable, Height Adjustable ArmrestsOnly available with desk length armpads.

1f. Height Adjustable, Cantilever ArmrestsHeight adjustment from 11"-17" depends on cane height. Not available with manual recline, flip forward back canes, or cane clamp pushbar.

1g. Single Post, Height Adjustable, Removable ArmrestsHeight adjustment from 11"-17" in half-inch increments.

Full Length, Flip Back Armrests .............................. StandardLeft part: FRMASMB7038. Right part: FRMASMB7039

Desk Length, Flip Back Armrests ............................ StandardLeft part: FRMASMB7040. Right part: FRMASMB7041

Full Length, Two-Post Armrests...............................$150 ea.Left part: FRMASMB7062. Right part: FRMASMB7063. HCPCS: E0973

Desk Length, Two-Post Armrests .............................$150 ea.Left part: FRMASMB7060. Right part: FRMASMB7061. HCPCS: E0973

Full Length, Heavy Duty Armrests, 8"-12" H ................$75 ea.Left part: FRMASMB9982. Right part: FRMASMB9983. HCPCS: E0973

Desk Length, Heavy Duty Armrests, 8"-12"H ................$75 ea.Left part: FRMASMB9984. Right part: FRMASMB9985. HCPCS: E0973

Full Length, Heavy Duty Armrests, 10"-14"H ................$75 ea.Left part: FRMASMB9986. Right part: FRMASMB9987. HCPCS: E0973

Desk Length, Heavy Duty Armrests, 10"-14"H ..............$75 ea.Left part: FRMASMB9988. Right part: FRMASMB9989. HCPCS: E0973

Full Length, Cantilever Armrests .......................... $97.50 ea.Left part: FRMASMB16188. Right part: FRMASMB16189

Desk Length, Cantilever Armrests ......................... $97.50 ea.Left part: FRMASMB16190. Right part: FRMASMB16191

Full Length, Single Post Armrests .............................$75 ea.Left part: FRMASMB8594. Right part: FRMASMB8595. HCPCS: E0973

Desk Length, Single Post Armrests ............................$75 ea.Left part: FRMASMB8592. Right part: FRMASMB8593. HCPCS: E0973

Pediatric, Removable Armrests ................................................................................................................................ $75 ea.Left part: FRMASMB10608. Right part: FRMASMB10609. HCPCS: E0973

14.7. Synergy ArmrestsREQUIRED with Synergy seating. Left (L) and right (R) boxes may be checked to configure different size arms within one section arm type.

14.8. Synergy ArmpadsREQUIRED with armrest selection above. Waterfall armpads may cause interference with the seat back. Armpads are configured as pairs.

14.9. Synergy Seat to FloorREQUIRED with Synergy seating.

Straight Armpads ..................................................... StandardDesk/Desk part: UPSASMB1022. Full/Full part: UPSASMB1021. Desk/Full part: UPSASMB1023

No Armpad Selection ............................................. No ChargePart: PTOINDV1373

Waterfall Armpads ................................................. No ChargeDesk/Desk part: UPSASMB1025. Full/Full part: UPSASMB1024. Desk/Full part: UPSASMB1026

15.875" STFPart: PTOINDV3652




15. TRU-BALANCE FLEX SEATING SYSTEMOptional. Seat width and depth can be adjusted in 1" increments from 15"W-22"W and 16"D-20"D. Maximum seat size 22"W x 20"D.

15.1. TRU-Balance Flex Frame SelectionTRU-Balance Flex Seating System ...............................................................................................................................No ChargePart: PTOINDV3853

15.2. TRU-Balance Flex Seat Dimension - WidthREQUIRED with TRU-Balance Flex seating. Maximum seat width is 22". Part number is SETWDTH plus number following # below.

15” W(#1005)

16” W(#1006)

17” W(#1007)

18” W(#1008)

19” W(#1009)

20” W(#1010)

21” W(#1011)

22” W(#1012)


15.3. TRU-Balance Flex Seat Dimension - DepthREQUIRED with TRU-Balance Flex seating. Maximum seat depth is 20". Part number is SETDPTH plus number following # below.

15” D(#1005)

16” D(#1006)

17” D(#1007)

18” D(#1008)

19” D(#1009)

20” D(#1010)

15.4. TRU-Balance Flex Back OptionsREQUIRED with TRU-Balance Flex seating. See the Synergy 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.

Synergy Back Cushion .................................................... $275Part: See XRefSelect a back cane type and height and back height.

TRU-Comfort, 20” Width or less....................................... $675Part: See XRef. HCPCS: E2620Select back height.

TRU-Comfort, 22” Width or greater .................................. $775Part: See XRef. HCPCS: E2621Select back height.

Sling Back .....................................................................$98Part: See XRefSelect a back height. Back cane height must match back height. Not available with flip up cantilever arms.

Omit Back ............................................................ No ChargePart: PTOINDV1287Select a back cane type and height in following section.

1. Back Selection

Synergy Back Cane ................................................ No ChargePart: FRMASMB15844Select a back cane height.

Flip Forward Back Cane ................................................. $150Part: FRMASMB15846Select a back cane height. Not available with oxygen holder, or cane mounted and cantilever armrests.





Manual Recline Back ..................................................... $750Part: FRMASMB12910. HCPCS: E1226Select an overall back height. Back canes will be 22” H. Not available with flip back armrests, cantilever armrests, TRU-Comfort Back, rear accessories, or articulating foot platform.

2. Back Cane Selection

Width

Synergy and TRU-Comfort Back Availability Chart

Synergy Back Synergy or TRU-Comfort Back

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3. TRU-Balance Flex Push Handles

4. TRU-Balance Flex Accessory Bar

6. TRU-Balance Flex Back Cane HeightOmit this selection if a TRU-Comfort back is selected. 16" and 17" back canes are not available with a Synergy Back and cane mounted, flip up armrests. 14" and 15" back canes are not available without push handles. Parts: See XRef, configuration selection with push handles selection.

5. TRU-Balance Flex Overall Back HeightRefer to the Synergy and TRU-Comfort back availability chart for stock order back size ranges. Parts: See XRef, configuration selection with back selection.

Accessory Bar ...............................................................................................................................................................$10012"W-16"W Part: MEC145955. 16"W-20"W Part: MEC143975.

Push Handles .......................................................... StandardPart: Configuration selection with back cane height

Omit Push Handles .........................................................$125Part: Configuration selection with back cane heightNot available with Sling Back. Minimum cane height is 16".









24” High Back25” High Back

TRU-Balance Flex seating section continued on following page.


1b. Flip Back, Cane Mounted ArmrestsMay interfere with swing-away laterals.

1a. Straight Armpads

1b. Waterfall Armpads

1c. Falcon Gel Armpads

1a. TRU-Balance Flex Seat, Drop-In Armrests

1c. Two-Post, Flip Back, Height Adjustable, Removable ArmrestsNot available with a depth less than 16". Required with flip forward back and laptrays.

1d. Single Post, Height Adjustable, Removable ArmrestsHeight adjustment from 11"-17" in half-inch increments.

Full Length, Flip Back Armrests (pair) .............................$60Left part: FRMASMB7038. Right part: FRMASMB7039. HCPCS: K0020

Desk Length, Flip Back Armrests (pair) ...........................$60Left part: FRMASMB7040. Right part: FRMASMB7041. HCPCS:K0020

Full Length, Two-Post Armrests...............................$150 ea.Part: See XRef. HCPCS: E0973

Desk Length, Two-Post Armrests .............................$150 ea.Part: See XRef. HCPCS: E0973

Full Length, Single Post Armrests .............................$75 ea.Left part: FRMASMB8594. Right part: FRMASMB8595. HCPCS: E0973

Desk Length, Single Post Armrests ............................$75 ea.Left part: FRMASMB8592. Right part: FRMASMB8593. HCPCS: E0973

15.5. TRU-Balance Flex ArmrestsREQUIRED with TRU-Balance Flex seating. Left (L) and right (R) boxes may be checked to configure different size arms within one section arm type.

15.6. TRU-Balance Flex ArmpadsREQUIRED with armrest selection above. Waterfall armpads may cause interference with the seat back. Armpads are configured as pairs.

Straight, Full Length Left and Right ........................... No ChargePart: ARM134275

Straight, Full Length Left, Desk Length Right ............... No ChargePart: ARM134281

Straight, Desk Length Left, Full Length Right ............... No ChargePart: ARM134275

Straight, Desk Length Left and Right .......................... No ChargePart: ARM134254

Waterfall, Full Length Left and Right .......................... No ChargePart: ARM134275

Waterfall, Full Length Left, Desk Length Right ............. No ChargePart: ARM134281

Waterfall, Desk Length Left, Full Length Right ............. No ChargePart: ARM134275

Waterfall, Desk Length Left and Right ........................ No ChargePart: ARM134254

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. TRU-BALANCE FLEX SEATING SYSTEM continued

16.1. Headrest Pads

16.2. Headrest Brackets

16. HEADRESTSOptional. Select a headrest pad and bracket. Not available with contoured seating.

Stealth’s Worlds Best Removable ..................$220.50Headrest Bracket (TWB485-1) (C)Part: FRMASMB15999. HCPCS: E1028

Stealth Multi-Axis Removable Headrest..........$160.50Bracket (HMO475P) (D)Part: HDWASMB1084. HCPCS: E1028Not available with TRU-Balance Flex seating.

Stealth 8” Comfort Plus (CP450) ................... $151.94Part: POS148484. HCPCS: E0955

Stealth 10” Comfort Plus (CP250)(A) ............. $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

Stealth Small Contoured (9.75”Wx3”H) .............$64.20(STL-OTSM250)Part: SETHEAD1052. HCPCS: E0955

Stealth Large Contoured (11”Wx6”H) (B) ........... $80.25(STL-OTLG150)Part: SETHEAD1053. HCPCS: E0955

Headrests

38” Lap BeltPart: ACCBELT1006






i-Fit 60” Single Pull, Push Button, Medium ...........................$86(7.5”) Padded, 1.5” Belt (IFPB5213)Part: ST-IFPB5213-Q

i-Fit 60” Single Pull, Push Button, Large ..............................$86Padded (9.5”), 2” Belt (IFPB5314)Part: ST-IFPB5314-Q

i-Fit 60” Single Pull, Push Button, Extra Large ......................$86Padded (11.5”), 2” Belt (IFPB5315)Part: ST-IFPB5315-Q

17.1a. Standard Lap Belts

17.1b. Optional Lap BeltsNot available with contoured or TRU-Balance Flex seating.

17. LAP BELTSREQUIRED. Select a lap belt below.

Full Length, Drop-In Armrests .............................. No ChargeLeft part: ARM1803253. Right part: ARM156742

Desk Length, Drop-In Armrests ............................ No ChargeLeft part: ARM1803254. Right part: ARM156743


4. Modular Footplate Extension ComponentsOptional. Assembly required. May require seating configuration adjustments to avoid front caster interference.

3. Center Mount Calf Support*Calf pads are standard with a power articulating foot platform. Select calf pads covers for additional charge. Calf pad and panel covers include 1/2” of soft visco foam.

Small Calf Pads (pair) 6”Wx6”H ....................................... $150*Part: RIGASMB7120018

Large Calf Pads (pair) 8” taper to 6”Wx8”H ....................... $150*Part: RIGASMB7120019

Small Calf Panel 18”Wx8”H ............................................. $150Part: FRMASMB7110012

Large Calf Panel 24”Wx8”H ............................................ $200Part: RIG123824Only available on widths of 20” or greater.

Width Extension for 8”D Footplates ...................................$50Part: RIG152517

Width Extension for 11”D Footplates ..................................$50Part: RIG152518

2” Bell-Shaped Length Extension .......................................$50Part: RIG152519Not compatible with width extensions. Can be used with 6” outside edge with 11” footplates.

4” Outside Edge (pair) .....................................................$50Part: RIG152510Only available with 6”D footplates and 8”D footplate extension.

6” Outside Edge (pair) .....................................................$50Part: RIG152516Available with 8”D and 11”D footplates and 11”D footplate extension.

Reversed Dartex Calf Pad Cover (pair) ............................... $150Small part: RIG133717. Large part: RIG133719

Reversed Dartex Panel Cover (pair) .................................. $150Small part: RIG134673. Large part: RIG134744

Wheel Bumpers (pair) ............................................. $12.50 ea.Part: WHLASMB1578 x2

Footplate Connector ....................................................... $15Part: RIGASMB7120023

8"-12" Extension, 5"x6" FootplatesPart: RIG152577Not available with power articulating platform.

8"-12" Extension, 5"x8" FootplatesPart: RIG152578Not available with power articulating platform.

10"-16" Extension, 5"x6" FootplatesPart: RIG150206






Power Articulating Foot Platform .................. $2,995Part: PTOINDV3754. HCPCS: E1012

Manually Adjustable Center Mount Foot Platform ... $250Part: RIG163640

20.1. 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. Not available with contoured or TRU-Balance Flex seating.

2. Lower Extension and Footplates

1. Foot Platform Assembly

5. Additional Accessories

Power ArticulatingFoot Platform

No interference issues at this seat-to-floor height.

May have less than 1.75” clearance when fully extended and may interfere with the ground or reduce obstacle climbing ability.

Center Mount Foot Platform Compatibility Matrix

Synergy SeatLow Medium High

10”-16” Length Extension

13”-19” Length Extension


Independent Legrests (Requires 2 actuator controls)Part: Configuration selection

Combined Legrests (Requires 1 actuator control)Part: Configuration selection

Articulating Foot Platform (Requires 1 Actuator Control)Part: Configuration selection

One Actuator Control through NE+ Joystick ...................... $1,895Part: See XRef. HCPCS for Articulating Foot Platform: E2310

Two Actuator Control through NE+ Joystick ......................$2,895Part: See XRef. HCPCS for power legrests: E2311

One Actuator Control through Q-Logic 2 .........................$2,895Part: See XRef. HCPCS for Articulating foot platform: E2310

Multiple Actuator Control through Q-Logic 2 .....................$2,895Part: See XRef. HCPCS for power legrests: E2311

18. SYNERGY SEAT POWER LEGREST CONTROLOptional. Specific power legrest options are selected later in this form. Select the control type here, if power legrests are desired, to assist the selection of the power positioning electronics.

19. SYNERGY POWER OPTION ELECTRONICSREQUIRED for Synergy Seat with Power Legrests. Select the desired control type for the seating system.

Legrests section continued on following page.

20. 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.


2. Angle Adjustable Footplate with Heel Loop and Wheel Bumper¹The 6”x11” footplates may cause interference with seat widths less than 18”. ²The 8”x11” footplates may cause interference with seat widths less than 20”.

1. Articulating Legrest Upper Assembly

20.2. 70° Power Articulating, Swing Away LegrestsNot available with contoured or TRU-Balance Flex seating seating. 4” of articulating range. Be sure power legrest control has been selected in previous section. Select an upper extension type and footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes. Select legrest length in following section.

70° Articulating, Swing-Away .......................$1,197.50 ea.Legrest with 14.5"-18" ExtensionPair Part: FRMASMB9073. Left Part: FRMASMB9074. Right Part: FRMASMB9075. HCPCS: E1010

70° Articulating, Swing-Away .......................$1,197.50 ea.Legrest with 11"-13" ExtensionPair Part: FRMASMB11444. Left Part: FRMASMB11366. Right Part: FRMASMB11367. HCPCS: E1010

3. Power Articulating, Swing-Away Legrest AccessoriesCalf Pad (pair) 6”Wx6”H .......................................... No ChargePart: MEC153735

Falcon Gel Padded Knee Adductor Buttons (KBE)(pair) ...........$125Part: INDPART2242. HCPCS: E0953^^Please verify the appropriate billing code to be used for this item with all third-party payors.

4”Wx6”DPair part: FRMASMB7448. Left part: RIG133543. Right part: RIG133566.



6”Wx8”D1Pair part: FRMASMB7451. Left part: RIG133547. Right part: RIG133569.



This rigging configuration causes no interference issues at this seat-to-floor height.This rigging configuration may have less than 1.75” clearance when fully extended and may interfere with the ground or reduce obstacle climbing ability.

70° Power Articulating, Swing-Away Legrest Compatibility Matrix


Angle Adjustable, 14.5” - 18”11” - 13”Angle Adjustable,



1. Pedatric Legrests Upper

2. Angle Adjustable Footplate(s) with Heel Loops

3. Accessories

90°, Pediatric, Swing-Away Legrest (7"-10" Length Extension) ............................................................................. $162.50 ea.Pair part: FRMASMB8808. Left: FRMASMB8809. Right: FRMASMB8810.

20.3. Pediatric, Swing-Away LegrestsNot available with TRU-Balance Flex seating. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes. Select legrest length in following section.

4”Wx6”D Angle Adjustable .................................$85 ea.Pair part: FRMASMB8812. Left: RIG133537. Right: RIG133560HCPCS: K0040

5”Wx6”D Angle Adjustable .................................$85 ea.Pair part: FRMASMB8811. Left: RIG133538. Right: RIG133561HCPCS: K0040

Wheel Bumper(s) .........................................................................................................................................$12.50 ea.Pair part: WHL169508. Left: WHL169510. Right: WHL169511

60°-90° Swing-Away Legrest ........................... No ChargePair part: RIG120062. Left: FRMASMB17558. Right: FRMASMB17559Not available with 11"-13" extensions.

60°-90° Swing-Away Legrest, Short .................. No ChargePair part: RIG136481. Left: RIG132607. Right: RIG132609.For use only with 11"-13" lower extensions.

20.4. 60°-90° Swing-Away LegrestsAdjustable in 5° increments. Select a legrest upper, a legrest extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes. Select legrest length in following section.1. Swing-Away Legrest Upper

This rigging configuration causes no interference issues at this seat-to-floor height.

This rigging configuration may have less than 1.75” clearance when fully extended and may interfere with the ground or reduce obstacle climbing ability.

This rigging configuration does not work with this seat-to-floor height.

60°-90° Swing-Away Legrest Compatibility Matrix

Contoured SeatLow Medium High

Extruded, 13” - 16.5”Extruded, 15.5” - 19.5”

Angle Adjustable, 13” - 16.5”Angle Adjustable, 15.5” - 19.5”

Multi-Axis, 15.5” - 19.5”


11”-13” LengthPart: See XRefN/A with Multi-axis.

11”-16.5” LengthPart: See XRefN/A with Angle Adjustable.

13”-16.5” LengthPart: See XRefN/A with Multi-Axis.

15.5”-19.5” LengthPart: See XRef

2. Lower Extension

20. LEGRESTS

3a. Extruded Footplate(s)7.25”Wx6”D Extruded Footplate ........................ StandardPart pair: FRMASMB7847. Left: FRMASMB7861 Right: FRMASMB7862

8.5”Wx6”D Extruded Footplate ......................... StandardPart pair: FRMASMB7848. Left: FRMASMB7863 Right: FRMASMB7864May cause interference on seat widths less than 18.”


3b. Angle Adjustable Footplate(s) with Heel Loops¹The 6”x11” footplates may cause interference with seat widths less than 18”. ²The 8”x11” footplates may cause interference with seat widths less than 20”. 4"x6" and 5"x6" footplates are only available in pairs.

5. Amputee Supports with Swing-Away UpperEnter a quantity for the amputee supports and covers. A 60°-90° legrest upper must be selected with the amputee support. The support will be configured with the legrest upper side that does not have a lower extension and footplate selected with it.

3c. Multi-Axis Footplate(s)¹The 6”x11” footplates may cause interference with seat widths less than 18”. ²The 8”x11” footplates may cause interference with seat widths less than 20”.

3b. Angle Adjustable Footplate(s)¹The 6”x11” footplates may cause interference with seat widths less than 18”. ²The 8”x11” footplates may cause interference with seat widths less than 20”.

20.4. 60°-90° Swing-Away Legrests continued


20. LEGRESTS continued

4”Wx6”D .......................................................$85 ea.Pair part: FRMASMB10564. Left: RIG133537. Right: RIG133560 HCPCS: K0040

5”Wx6”D........................................................$85 ea.Pair part: FRMASMB10565. Left: RIG133538. Right: RIG133561HCPCS: K0040

5”Wx8”D .......................................................$85 ea.Pair part: FRMASMB10566. Left: RIG133539. Right: RIG133562HCPCS: K0040

6”Wx8”D1 ......................................................$85 ea.Pair part: FRMASMB10567. Left: RIG133540. Right: RIG133563HCPCS: K0040

6”Wx11”D1 .....................................................$85 ea.Pair part: FRMASMB10568. Left: RIG133541. Right: RIG133564HCPCS: K0040


4”Wx6”D ................................................. $247.50 ea.Pair part: FRMASMB9456. Left: RIG133531. Right: RIG133552HCPCS: K0040

5”Wx6”D.................................................. $247.50 ea.Pair part: FRMASMB9457. Left: RIG133532. Right: RIG133553HCPCS: K0040

5”Wx8”D ................................................. $247.50 ea.Pair part: FRMASMB9458. Left: RIG133533. Right: RIG133554HCPCS: K0040

6”Wx8”D1 ................................................ $247.50 ea.Pair part: FRMASMB9459. Left: RIG133534. Right: RIG133555HCPCS: K0040

6”Wx11”D1 ............................................... $247.50 ea.Pair part: FRMASMB9460. Left: RIG133535. Right: RIG133558HCPCS: K0040

8”Wx11”D2 ............................................... $247.50 ea.Pair part: FRMASMB9461. Left: RIG133536. Right: RIG133559HCPCS: K0040


4. 60°-90° Swing-Away Legrest AccessoriesHeel Loops (pair) ............................................................$50Part: FRMASMB7873. HCPCS: E0951Standard on angle adjustable and multi-axis footplates.

Wheel Bumper ...................................................... $12.50 ea.Part: See XRef

Gel Neoprene Footrest Sleeve (pair) ...................................$80Part: INDPART2243. HCPCS: K0108

Therafin 31515 Multi-Axis Amputee Support ............. $230 ea.Part: INDPART2822. HCPCS: E1020

Therafin 32387 Amputee Support Gel Cover ..............$155 ea.Part: INDPART2823. HCPCS: K0108

1. Elevating Legrests Upper

2. Lower Extension11”-14” LengthPair: FRMASMB4755Left: RIG138026Right: RIG138030For reinforced only

12”-14.5” LengthPart: See XRefFor angle adjustable only

14”-17” LengthPair: FRMASMB4756Left: RIG138033Right: RIG138035For reinforced only

14.5”-18” LengthPart: See XRefFor angle adjustable only

Elevating Legrest Assembly .......................... $162.50 ea.Pair part: FRMASMB6483. Left: RIG138012Right: RIG138013. HCPCS: E0990Select lower extension and footplates

20.5. Elevating LegrestsSelect a legrest upper, a legrest extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes. Select legrest length in following section.

This rigging configuration causes no interference issues at this seat-to-floor height.This rigging configuration may have less than 1.75” clearance when fully extended and may interfere with the ground or reduce obstacle climbing ability.This rigging configuration does not work with this seat-to-floor height.

Contoured SeatLow Medium High


Elevating LegrestCompatibility Matrix

Standard, 11”-14”Standard, 14”-17”

Angle Adjustable, 12”-14.5”Angle Adjustable, 14.5”-18”

3a. Reinforced Cast Footplate(s)7.25”Wx6”D Reinforced Footplate ...................... StandardPair part: FRMASMB4748. Left: RIG138055. Right: RIG138056

8.5”Wx6”D Reinforced Footplate ....................... StandardPair part: FRMASMB4747. Left: RIG138060. Right: RIG138062May cause interference on seat widths less than 18.”

4”Wx6”D .......................................................$85 ea.Pair parts: FRMASMB8812 x2.HCPCS: K0040

5”Wx6”D........................................................$85 ea.Pair parts: FRMASMB8811 x2.HCPCS: K0040

5”Wx8”D .......................................................$85 ea.Pair part: FRMASMB4735. Left: RIG137791. Right: RIG137792HCPCS: K0040

6”Wx8”D1 ......................................................$85 ea.Pair part: FRMASMB4738. Left: RIG137793. Right: RIG137795HCPCS: K0040





4. Elevating Legrest AccessoriesHeel Loops (pair) ............................................................$50Part: FRMASMB7873. HCPCS: E0951Standard on angle adjustable footplates.

Wheel Bumper ...................................................... $12.50 ea.Part: See XRefAvailable on angle adjustable footplates.

Falcon Gel Padded Knee Adductor Buttons (KBE) (pair) ..........$125Part: INDPART2242. HCPCS: E0953^^Please verify the appropriate billing code to be used for this item with all third-party payors.

20. LEGRESTS continued

7” L(#3470)

7.5” L(#3471)

8” L(#3472)

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)

18.5” L(#3493)

19” L(#3494)

19.5” L(#3495)

20” L(#3496)

20.5” L(#3497)

21” L(#3498)

21.5” L(#3600)

22” L(#3669)

22.5” L(#3670)

21. SET LEGREST LENGTHREQUIRED with matching left and right legrest configuration. 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.

20.5. Elevating Legrests continued

TRU-Comfort 2 SPP CushionSkin protection and positioning with 4-way stretch, breathable cover.

E2607, 16"W to 20" W ...........................$400E2608, 22"W ......................................$500

Part series: ST-TC2SPPXXYY

Simplicity G CushionGeneral use with 2-way stretch, breathable cover.

E2601, 16"W to 20" W ........................... $110E2602, 22"W ...................................... $165

Part series: ST-SIMGXXYY

22. QUICK STEALTH CUSHION CONFIGURATIONOptional. Specific cushion/component sizes available, part numbers, and special order cushions can be found on the complete Stealth Cushion Order Form. This section allows a quick selection of a single cushion. The XXYY portion of the part number directly relates to the dimensions of the cushion, where XX represents the width and YY represents the depth.

22.1. Cushion Dimensions

22.2. Cushion Model Selection

22.3. Additional Fluid Proof LinersFluid Proof Urethane Liner ......................................... $50-$70Part: URL1709070-XXYYNot available with Simplicity and TRU-Comfort 2.

Fluid Proof Polyurethane Liner .............................. Coming soonNot available with Simplicity.

Install Liner on Cushion

Solution SPP CushionSkin protection and positioning with 4-way stretch, breathable cover. Includes urethane liner.

E2607, 14"W to 20" W ........................... $375E2608, 22"W ...................................... $430

Part series: ST-SOLSPPXXYY

Spectrum Gel SPP CushionPositioning with 4-way stretch, breathable cover. Includes urethane liner.Part series: ST-SPCGSPPXXYY

E2607, 14"W to 20" W ...........................$460E2608, 22"W ...................................... $530

Spectrum Foam SPP CushionSkin protection and positioning with 4-way stretch, breathable cover.Part series: ST-SPCFSPPXXYY

E2607, 16"W to 20" W ...........................$460E2608, 22"W ...................................... $530

14” W 16" W 17" W 18" W 19" W 20" W 22" W 14” D 16" D 17" D 18" D 19" D 20" D 22" D

Liner Installation

Cushion Width Cushion Depth

https://www.pridemobility.com/pdf/order-forms/seating/us_stealth_cushions_order_form.pdf



Medium, Black, Weather Cover ........................................ $168Part: ACCCOVR1022

Large, Black, Weather Cover ........................................... $202Part: ACCCOVR1021

Oxygen Holder ..............................................................$118Contoured seat part: ACCASMB2292. Synergy part: FRMASMB7030.Flex part: ACC125006. HCPCS: E2208Not available with Synergy Manual Recline.

Contoured Seat Cup Holder...............................................$20 Part: ACCASMB2287

Synergy/Flex* Seat Cup Holder ................................. No ChargePart: ACCASMB2634*Not available on TRU-Balance Flex seating without two-post armrests.

Rear Basket .................................................................$118Contoured seat part: ACCASMB1914Synergy/Flex part: FRMASMB4821

Walker Holder ............................................................. $103Contoured seat part: ACCASMB1912. Synergy/Flex part: FRMASMB7031

Saddle Bag ....................................................................$35Part: DWR1020D010

Flag Holder ...................................................................$25Contoured seat part: ACCASMB1930Synergy/Flex part: ACCASMB2415.

Cane/Crutch Holder .......................................................$110Contoured seat part: ACCASMB2294. HCPCS: E2207Synergy part: FRMASMB4822. Flex part: ACC152515. HCPCS: E2207

23. PROVIDER INSTALLED ACCESSORIESOptional. Multiple accessories can be mounted along the various tracks but some interference may occur.

Group 24, Gel Cell (Interceptor) .................................. $365 ea. Part: BAT1704614. HCPCS: E2363

Group 24, Gel Cell (MK) ............................................. $410 ea. Part: BAT121347. HCPCS: E2363

No batteries. Provider will assume responsibility of batteries.Part: Configuration selection

24. BATTERIESREQUIRED. The powerchair requires 2 batteries and will be installed if ordered.

Air Force Army Coast Guard Marines Navy Purple Heart

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

25. BRANCH PATCHESOptional.

1. Bracket

2. Pads

3. 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

Install LateralsPart: PTOINDV3499

Do Not InstallPart: PTOINDV3500

26.1. 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.

26. MANUFACTURER INSTALLED POSITIONING COMPONENTSOptional. Not available with contoured seating. More options are available on the Positioning Components Order Form.

Manufacturer installed positioning components section continued on following page.

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

1. Pelvic/Thigh Guide Bracket

2. Pelvic/Thigh Guide Adapter

26.2. Stealth Pelvic/Thigh GuidesPelvic/thigh guides may interfere with the joystick receiver block and down posts. Please provide quantity next to check box.

2” 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.

http://www.quantumrehab.com/resources/downloadorderforms.php?f=seating/us_positioning_components_order_form.pdf


3. Pelvic/Thigh Guide Pad^Please verify the appropriate billing code to be used for this item with all third-party payors.


4. Pelvic/Thigh Guide Installation

27.1. Stealth Foot Boxes^Please verify the appropriate billing code to be used for this item with all third-party payors.

27.2. Stealth Padded Shoe Holder

Short Pad, 4”x4” (TWBADD-4X4) ..............................$75 ea.Part: INDPART2801. HCPCS: E0953^

Medium Pad, 4”x8” (TWBADD-4X8) ...........................$75 ea.Part: INDPART2802. HCPCS: E0953^

Long Pad, 4”x12” (TWBADD-4X12) ............................$75 ea.Part: INDPART2803. HCPCS: E0953^

Install on LeftPart: PTOINDV3585

Install on RightPart: PTOINDV3586

Do Not InstallPart: PTOINDV3719

Stealth 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^

Stealth Small Padded Shoe Holder 3.75"Wx6.25"D ................ $266(SPLE111) (pair)Part: INDPART2783.

Stealth Medium Padded Shoe Holder, 4"Wx8.25"D ................ $266(SPLE112) (pair)Part: INDPART2784.

Stealth X-Large Padded Shoe Holder, 5"Wx10.75"D ............... $266(SPLE114) (pair)Part: INDPART2785.

27. PROVIDER INSTALLED POSITIONING COMPONENTSOptional. Not available with contoured seating. More options are available on the Positioning Components Order Form.

26. MANUFACTURER INSTALLED POSITIONING COMPONENTS continued

Provider installed positioning components section continued on following page.

2. Elbow Support Pad

1. Elbow Support Bracket27.3. Stealth Elbow Support

Left,Swing-Away, Elbow Support Bracket ..............$183.75 ea. 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 Bracket ............$183.75 ea. 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

26.2. Stealth Pelvic/Thigh Guides continued

27.4. Stealth i-Fit Chest Harness

27.5. Stealth i-Fit Chest Straps

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 ............. $90 ea.(IFCS4113)Part: ST-IFCS4113-Q. HCPCS: E0960

Chest Strap, Large w/ Belt Anchor ................ $90 ea.(IFCS4114)Part: ST-IFCS4114-Q. HCPCS: E0960

Contoured and ClassicChest Harness

Chest Strap



Q-Logic 2 Enhanced Display ShroudRequired with Q-Logic 2 Enhanced Display selection above. Reference colors shown on page 2.


1" Ball Kit for Facial Laterals (TWB-1BK) (D) ..... $80.25Part: POS150532Required with facial laterals to mount to comfort head-rest brackets.

Egg 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, ..................$250 ea. 18" Rod (C)

Part: ST-SUS18-Q Allows mounting of facial pads and attaches to the headrest

Enhanced Display

28.1. Enhanced Display













Black, Soft Touch ....................................StandardPart: DGN137728

Non-matching Joystick Shroud.......................... $50Select color below

Match Joystick Shroud to Base Color .................. $50Part: See color below

Q-Logic 2 Enhanced Display Kit .....................................................................................................$1,720Part: KIT140039Select 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.

27. PROVIDER INSTALLED POSITIONING COMPONENTS continued

28. SPECIALTY CONTROLSOptional. Only available with the Synergy Seating system. Select a type of specialty controls below or to refer to the specialty controls order form.

Specialty electronics continued on following page.

Facial Lateral Pads and Accessories

27.6. Stealth Swing-Away Headrest MountsThese swing-away headrest mounts are only available with the Stealth Comfort Series headrests. The 1" ball kit must be selected to mount the facial lateral to the headrest bracket. Also select a facial pad(s) with the facial lateral(s).

Facial 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

Left and Right FacialLateral with Pads

Headrest Accessories

28.2. 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

28.3. Sip and Puff DriveSip and Puff Module for Q-Logic 2 ..................................................................................................$1,895Part: KITASMB1697 Includes module and bus cable.

Sip & Puff Module



28.4. Egg Switches

28.5. Switch Adapter

Egg Switch

Alternative Controls & Electronics Order Form Positioning Components Order Form

28. SPECIALTY CONTROLS continued

29. REFERENCE ORDER FORMSOptional. Select below to note that additional order forms will accompany this order form. This will also be a link in interactive forms.

Red Egg Switch (ESRED) ..................... $80.85 ea. Part: SWTMCRO1077

Blue Egg Switch (ESBLU) .................... $80.85 ea.Part: SWTMCRO1079

Black Egg Switch (ESBLK) ................... $80.85 ea.Part: SWTMCRO1081

Green Egg Switch (ESGRN) ................. $80.85 ea.Part: SWTMCRO1078

Yellow Egg Switch (ESYEL) ................. $80.85 ea.Part: SWTMCRO1080

2 to 1 Switch Adapter .................................................................................................................................................. $13.39Part: DWR1361H037 Connects 2 single switches to a stereo jack to act as a dual switch.

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Section NameOption Name MSRP Part Number Manufacturer Extended DescriptionELECTRONICSQ-Logic 2 EX Controller Module $695 ELE132484 ELECTRONIC,ASSY,Q-LOGIC,G4,5 MPH,125 RPM MOTORS,R44

ELE132485 ELECTRONIC,ASSY,Q-LOGIC,G4,5 MPH,125 RPM MOTORS,R44,TILT THRU TOGGLEELE132486 ELECTRONIC,ASSY,Q-LOGIC,G4,5 MPH,125 RPM MOTORS,R44,QUANTUMELE132487 ELECTRONIC,ASSY,Q-LOGIC,G4,6 MPH,160 RPM MOTORS,R44ELE132488 ELECTRONIC,ASSY,Q-LOGIC,G4,6 MPH,160 RPM MOTORS,R44,TILT THRU TOGGLEELE132489 ELECTRONIC,ASSY,Q-LOGIC,G4,6 MPH,160 RPM MOTORS,R44,QUANTUMELE132490 ELECTRONIC,ASSY,Q-LOGIC,G4,6 MPH,160 RPM ACCU-TRAC MOTORS,R44,UNIVERSAL/TILT THRU TOGELE132491 ELECTRONIC,ASSY,Q-LOGIC,G4,6 MPH,160 RPM ACCU-TRAC MOTORS,R44,QUANTUMELE132492 ELECTRONIC,ASSY,Q-LOGIC,G4,8 MPH,190 RPM MOTORS,R44ELE132493 ELECTRONIC,ASSY,Q-LOGIC,G4,8 MPH,190 RPM MOTORS,R44,TILT THRU TOGGLEELE132494 ELECTRONIC,ASSY,Q-LOGIC,G4,8 MPH,190 RPM MOTORS,R44,QUANTUMELE132495 ELECTRONIC,ASSY,NE PLUS,G4,5 MPH,125 RPM MOTORS,R44ELE132496 ELECTRONIC,ASSY,NE PLUS,G4,5 MPH,125 RPM MOTORS,R44,TILT THRU TOGGLEELE132497 ELECTRONIC,ASSY,NE PLUS,G4,5 MPH,125 RPM MOTORS,R44,QUANTUMELE132498 ELECTRONIC,ASSY,NE PLUS,G4,6 MPH,160 RPM MOTORS,R44ELE132499 ELECTRONIC,ASSY,NE PLUS,G4,6 MPH,160 RPM MOTORS,R44,TILT THRU TOGGLEELE132500 ELECTRONIC,ASSY,NE PLUS,G4,6 MPH,160 RPM MOTORS,R44,QUANTUMELE132501 ELECTRONIC,ASSY,NE PLUS,G4,8 MPH,190 RPM MOTORS,R44ELE132502 ELECTRONIC,ASSY,NE PLUS,G4,8 MPH,190 RPM MOTORS,R44,TILT THRU TOGGLEELE132503 ELECTRONIC,ASSY,NE PLUS,G4,8 MPH,190 RPM MOTORS,R44,QUANTUM

JOYSTICK MOUNTING BRACKETSSwing-away, Inline, Left Side Mount $245 ACC142526 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,LEFT,NE/NE PLUS

ACC148360 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY ,INLINE,LEFT,NE/NE PLUS,CAPTAINS SEAT

ACC142524 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,LEFT,Q-LOGIC ACC148356 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,LEFT,Q-LOGIC,CAPTAINS SEAT

Swing-away, Inline, Right Side Mount $245 ACC142527 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,RIGHT,NE/NE PLUSACC148361 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY ,INLINE,RIGHT,NE/NE PLUS,CAPTAINS SEAT

ACC142525 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,RIGHT,Q-LOGIC ACC148357 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,INLINE,RIGHT,Q-LOGIC,CAPTAINS SEAT

Swing-away, 1" Offset, Left Side Mount $245 ACC142747 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,LEFT,NE/NE PLUSACC148362 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,LEFT,NE/NE PLUS,CAPTAINS SEAT

ACC142525 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,LEFT,Q-LOGICACC148358 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,LEFT,Q-LOGIC,CAPTAINS SEAT

Swing-away, 1" Offset, Right Side Mount $245 ACC142748 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,RIGHT,NE/NE PLUSACC148363 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,RIGHT,NE/NE PLUS,CAPTAINS SEAT

ACC142743 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,RIGHT,Q-LOGICACC148359 JOYSTICK MOUNTING BRACKET,ASSY,SWING AWAY,OFFSET,RIGHT,Q-LOGIC,CAPTAINS SEAT

SYNERGY BACK OPTIONS - Back SelectionTRU-BALANCE FLEX BACK OPTIONS - Back SelectionSynergy Back $275 SETASMB6448 SEAT BACK,ASSY,SYNERGY STANDARD BACK,12"W,15"H,W/CUSHION,(12"W X 12"H BACK)

SETASMB6624 SEAT BACK,ASSY,SYNERGY STANDARD BACK,12"W,16"H,W/CUSHION,(12"W X 12"H BACK)








Rival Cross Reference Spreadsheet - Contoured, Synergy, and TRU-Balance Flex Seating

Page 1 of 9

Section NameOption Name MSRP Part Number Manufacturer Extended Description



























SETASMB6640 SEAT BACK,ASSY,SYNERGY STANDARD BACK,17"W,18''D,W/CUSHION,(17"W X 14"H BACK)






















Page 2 of 9


































TRU-Comfort 4-way Stretch, 20" Width or less $675 SETASMB7082 SEAT BACK,ASSY,BLACK,16"W,20"H,TRU-COMFORT SEAT,SYNERGY SEAT/TRU-BALANCE POWER TILT

SETASMB7151 SEAT BACK,ASSY,BLACK,16"W,21"H,TRU-COMFORT SEAT,SYNERGY SEAT/TRU-BALANCE POWER TILT








Page 3 of 9






























TRU-Comfort 4-way Stretch, 22" Width or greater $775 SETASMB7095 SEAT BACK,ASSY,BLACK,22"W,24"H,TRU-COMFORT SEAT,SYNERGY SEAT/TRU-BALANCE POWER TILT

Page 4 of 9










Sling Back $98 SETASMB3740 SEAT BACK,ASSY,SLING,13"W,18"H,(13"W X 15"H BACK),SYNERGY SEATSETASMB3741 SEAT BACK,ASSY,SLING,13"W,19"H,(13"W X 15"H BACK),SYNERGY SEATSETASMB3742 SEAT BACK,ASSY,SLING,13"W,20"H,(13"W X 17"H BACK),SYNERGY SEATSETASMB3743 SEAT BACK,ASSY,SLING,13"W,21"H,(13"W X 17"H BACK),SYNERGY SEATSETASMB3744 SEAT BACK,ASSY,SLING,13"W,22"H,(13"W X 19"H BACK),SYNERGY SEATSETASMB3745 SEAT BACK,ASSY,SLING,13"W,23"H,(13"W X 19"H BACK),SYNERGY SEATSETASMB3746 SEAT BACK,ASSY,SLING,13"W,24"H,(13"W X 21"H BACK),SYNERGY SEATSETASMB3747 SEAT BACK,ASSY,SLING,13"W,25"H,(13"W X 21"H BACK),SYNERGY SEATSETASMB3748 SEAT BACK,ASSY,SLING,14"W,18"H,(14"W X 15"H BACK),SYNERGY SEATSETASMB3749 SEAT BACK,ASSY,SLING,14"W,19"H,(14"W X 15"H BACK),SYNERGY SEATSETASMB3750 SEAT BACK,ASSY,SLING,14"W,20"H,(14"W X 17"H BACK),SYNERGY SEATSETASMB3751 SEAT BACK,ASSY,SLING,14"W,21"H,(14"W X 17"H BACK),SYNERGY SEATSETASMB3752 SEAT BACK,ASSY,SLING,14"W,22"H,(14"W X 19"H BACK),SYNERGY SEATSETASMB3753 SEAT BACK,ASSY,SLING,14"W,23"H,(14"W X 19"H BACK),SYNERGY SEATSETASMB3754 SEAT BACK,ASSY,SLING,14"W,24"H,(14"W X 21"H BACK),SYNERGY SEATSETASMB3755 SEAT BACK,ASSY,SLING,14"W,25"H,(14"W X 21"H BACK),SYNERGY SEATSETASMB3756 SEAT BACK,ASSY,SLING,15"W,18"H,(15"W X 15"H BACK),SYNERGY SEATSETASMB3757 SEAT BACK,ASSY,SLING,15"W,19"H,(15"W X 15"H BACK),SYNERGY SEATSETASMB3758 SEAT BACK,ASSY,SLING,15"W,20"H,(15"W X 17"H BACK),SYNERGY SEATSETASMB3760 SEAT BACK,ASSY,SLING,15"W,21"H,(15"W X 17"H BACK),SYNERGY SEATSETASMB3761 SEAT BACK,ASSY,SLING,15"W,22"H,(15"W X 19"H BACK),SYNERGY SEATSETASMB3762 SEAT BACK,ASSY,SLING,15"W,23"H,(15"W X 19"H BACK),SYNERGY SEATSETASMB3763 SEAT BACK,ASSY,SLING,15"W,24"H,(15"W X 21"H BACK),SYNERGY SEATSETASMB3764 SEAT BACK,ASSY,SLING,15"W,25"H,(15"W X 21"H BACK),SYNERGY SEATSETASMB3765 SEAT BACK,ASSY,SLING,16"W,18"H,(16"W X 15"H BACK),SYNERGY SEATSETASMB3766 SEAT BACK,ASSY,SLING,16"W,19"H,(16"W X 15"H BACK),SYNERGY SEATSETASMB3767 SEAT BACK,ASSY,SLING,16"W,20"H,(16"W X 17"H BACK),SYNERGY SEATSETASMB3768 SEAT BACK,ASSY,SLING,16"W,21"H,(16"W X 17"H BACK),SYNERGY SEATSETASMB3769 SEAT BACK,ASSY,SLING,16"W,22"H,(16"W X 19"H BACK),SYNERGY SEATSETASMB3770 SEAT BACK,ASSY,SLING,16"W,23"H,(16"W X 19"H BACK),SYNERGY SEATSETASMB3771 SEAT BACK,ASSY,SLING,16"W,24"H,(16"W X 21"H BACK),SYNERGY SEATSETASMB3772 SEAT BACK,ASSY,SLING,16"W,25"H,(16"W X 21"H BACK),SYNERGY SEATSETASMB3773 SEAT BACK,ASSY,SLING,17"W,18"H,(17"W X 15"H BACK),SYNERGY SEATSETASMB3774 SEAT BACK,ASSY,SLING,17"W,19"H,(17"W X 15"H BACK),SYNERGY SEATSETASMB3775 SEAT BACK,ASSY,SLING,17"W,20"H,(17"W X 17"H BACK),SYNERGY SEATSETASMB3776 SEAT BACK,ASSY,SLING,17"W,21"H,(17"W X 17"H BACK),SYNERGY SEATSETASMB3777 SEAT BACK,ASSY,SLING,17"W,22"H,(17"W X 19"H BACK),SYNERGY SEATSETASMB3778 SEAT BACK,ASSY,SLING,17"W,23"H,(17"W X 19"H BACK),SYNERGY SEATSETASMB3779 SEAT BACK,ASSY,SLING,17"W,24"H,(17"W X 21"H BACK),SYNERGY SEATSETASMB3780 SEAT BACK,ASSY,SLING,17"W,25"H,(17"W X 21"H BACK),SYNERGY SEAT

Page 5 of 9



SETASMB3781 SEAT BACK,ASSY,SLING,18"W,18"H,(18"W X 15"H BACK),SYNERGY SEATSETASMB3782 SEAT BACK,ASSY,SLING,18"W,19"H,(18"W X 15"H BACK),SYNERGY SEATSETASMB3783 SEAT BACK,ASSY,SLING,18"W,20"H,(18"W X 17"H BACK),SYNERGY SEATSETASMB3784 SEAT BACK,ASSY,SLING,18"W,21"H,(18"W X 17"H BACK),SYNERGY SEATSETASMB3785 SEAT BACK,ASSY,SLING,18"W,22"H,(18"W X 19"H BACK),SYNERGY SEATSETASMB3786 SEAT BACK,ASSY,SLING,18"W,23"H,(18"W X 19"H BACK),SYNERGY SEATSETASMB3787 SEAT BACK,ASSY,SLING,18"W,24"H,(18"W X 21"H BACK),SYNERGY SEATSETASMB3788 SEAT BACK,ASSY,SLING,18"W,25"H,(18"W X 21"H BACK),SYNERGY SEATSETASMB3789 SEAT BACK,ASSY,SLING,19"W,18"H,(19"W X 15"H BACK),SYNERGY SEATSETASMB3790 SEAT BACK,ASSY,SLING,19"W,19"H,(19"W X 15"H BACK),SYNERGY SEATSETASMB3791 SEAT BACK,ASSY,SLING,19"W,20"H,(19"W X 17"H BACK),SYNERGY SEATSETASMB3792 SEAT BACK,ASSY,SLING,19"W,21"H,(19"W X 17"H BACK),SYNERGY SEATSETASMB3793 SEAT BACK,ASSY,SLING,19"W,22"H,(19"W X 19"H BACK),SYNERGY SEATSETASMB3794 SEAT BACK,ASSY,SLING,19"W,23"H,(19"W X 19"H BACK),SYNERGY SEATSETASMB3795 SEAT BACK,ASSY,SLING,19"W,24"H,(19"W X 21"H BACK),SYNERGY SEATSETASMB3796 SEAT BACK,ASSY,SLING,19"W,25"H,(19"W X 21"H BACK),SYNERGY SEATSETASMB3797 SEAT BACK,ASSY,SLING,20"W,18"H,(20"W X 15"H BACK),SYNERGY SEATSETASMB3798 SEAT BACK,ASSY,SLING,20"W,19"H,(20"W X 15"H BACK),SYNERGY SEATSETASMB3799 SEAT BACK,ASSY,SLING,20"W,20"H,(20"W X 17"H BACK),SYNERGY SEATSETASMB3800 SEAT BACK,ASSY,SLING,20"W,21"H,(20"W X 17"H BACK),SYNERGY SEATSETASMB3801 SEAT BACK,ASSY,SLING,20"W,22"H,(20"W X 19"H BACK),SYNERGY SEATSETASMB3802 SEAT BACK,ASSY,SLING,20"W,23"H,(20"W X 19"H BACK),SYNERGY SEATSETASMB3803 SEAT BACK,ASSY,SLING,20"W,24"H,(20"W X 21"H BACK),SYNERGY SEATSETASMB3804 SEAT BACK,ASSY,SLING,20"W,25"H,(20"W X 21"H BACK),SYNERGY SEATSETASMB3805 SEAT BACK,ASSY,SLING,21"W,18"H,(21"W X 15"H BACK),SYNERGY SEATSETASMB3806 SEAT BACK,ASSY,SLING,21"W,19"H,(21"W X 15"H BACK),SYNERGY SEATSETASMB3807 SEAT BACK,ASSY,SLING,21"W,20"H,(21"W X 17"H BACK),SYNERGY SEATSETASMB3808 SEAT BACK,ASSY,SLING,21"W,21"H,(21"W X 17"H BACK),SYNERGY SEATSETASMB3809 SEAT BACK,ASSY,SLING,21"W,22"H,(21"W X 19"H BACK),SYNERGY SEATSETASMB3810 SEAT BACK,ASSY,SLING,21"W,23"H,(21"W X 19"H BACK),SYNERGY SEATSETASMB3811 SEAT BACK,ASSY,SLING,21"W,24"H,(21"W X 21"H BACK),SYNERGY SEATSETASMB3812 SEAT BACK,ASSY,SLING,21"W,25"H,(21"W X 21"H BACK),SYNERGY SEATSETASMB3813 SEAT BACK,ASSY,SLING,22"W,18"H,(22"W X 15"H BACK),SYNERGY SEATSETASMB3814 SEAT BACK,ASSY,SLING,22"W,19"H,(22"W X 15"H BACK),SYNERGY SEATSETASMB3815 SEAT BACK,ASSY,SLING,22"W,20"H,(22"W X 17"H BACK),SYNERGY SEATSETASMB3816 SEAT BACK,ASSY,SLING,22"W,21"H,(22"W X 17"H BACK),SYNERGY SEATSETASMB3817 SEAT BACK,ASSY,SLING,22"W,22"H,(22"W X 19"H BACK),SYNERGY SEATSETASMB3818 SEAT BACK,ASSY,SLING,22"W,23"H,(22"W X 19"H BACK),SYNERGY SEATSETASMB3819 SEAT BACK,ASSY,SLING,22"W,24"H,(22"W X 21"H BACK),SYNERGY SEATSETASMB3820 SEAT BACK,ASSY,SLING,22"W,25"H,(22"W X 21"H BACK),SYNERGY SEAT

SYNERGY BACK OPTIONS - Synergy Back Cane Height14" High Canes Standard FRMASMB15832 BACK CANE,ASSY,W/SHORT PUSH HANDLE,14"H,6 HOLE,SYNERGY,TEXTURED

Standard FRMASMB17097 BACK CANE,ASSY,W/SHORT PUSH HANDLE,14"H,SLING,SYNERGY,TEXTURED15" High Canes Standard FRMASMB15833 BACK CANE,ASSY,W/SHORT PUSH HANDLE,15"H,6 HOLE,SYNERGY,TEXTURED

Standard FRMASMB17098 BACK CANE,ASSY,W/SHORT PUSH HANDLE,15"H,SLING,SYNERGY,TEXTURED16" High Canes Standard FRMASMB15834 BACK CANE,ASSY,W/SHORT PUSH HANDLE,16"H,6 HOLE,SYNERGY,TEXTURED

Standard FRMASMB17099 BACK CANE,ASSY,W/SHORT PUSH HANDLE,16"H,SLING,SYNERGY,TEXTURED$62.50 x 2qty FRMASMB15774 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,16"H,6 HOLE,SYNERGY,TEXTURED

17" High Canes Standard FRMASMB15835 BACK CANE,ASSY,W/SHORT PUSH HANDLE,17''H,6 HOLE,SYNERGY,TEXTUREDStandard FRMASMB17100 BACK CANE,ASSY,W/SHORT PUSH HANDLE,17''H,SLING,SYNERGY,TEXTURED

$62.50 x 2qty FRMASMB15775 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,17''H,6 HOLE,SYNERGY,TEXTURED18" High Canes Standard FRMASMB15836 BACK CANE,ASSY,W/SHORT PUSH HANDLE,18"H,6 HOLE,SYNERGY,TEXTURED

Standard FRMASMB17101 BACK CANE,ASSY,W/SHORT PUSH HANDLE,18"H,SLING,SYNERGY,TEXTURED

Page 6 of 9



$62.50 x 2qty FRMASMB15776 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,18"H,6 HOLE,SYNERGY,TEXTURED19" High Canes Standard FRMASMB15837 BACK CANE,ASSY,W/SHORT PUSH HANDLE,19"H,6 HOLE,SYNERGY,TEXTURED


20" High Canes Standard FRMASMB15838 BACK CANE,ASSY,W/SHORT PUSH HANDLE,20"H,6 HOLE,SYNERGY,TEXTUREDStandard FRMASMB17103 BACK CANE,ASSY,W/SHORT PUSH HANDLE,20"H,SLING,SYNERGY,TEXTURED

$62.50 x 2qty FRMASMB15778 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,20"H,6 HOLE,SYNERGY,TEXTURED21" High Canes Standard FRMASMB15839 BACK CANE,ASSY,W/SHORT PUSH HANDLE,21''H,6 HOLE,SYNERGY,TEXTURED

Standard FRMASMB17104 BACK CANE,ASSY,W/SHORT PUSH HANDLE,21''H,SLING,SYNERGY,TEXTURED$62.50 x 2qty FRMASMB15779 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,21''H,6 HOLE,SYNERGY,TEXTURED

22" High Canes Standard FRMASMB15840 BACK CANE,ASSY,W/SHORT PUSH HANDLE,22''H,6 HOLE,SYNERGY,TEXTUREDStandard FRMASMB17105 BACK CANE,ASSY,W/SHORT PUSH HANDLE,22''H,SLING,SYNERGY,TEXTURED

$62.50 x 2qty FRMASMB15780 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,22''H,6 HOLE,SYNERGY,TEXTURED23" High Canes Standard FRMASMB15841 BACK CANE,ASSY,W/SHORT PUSH HANDLE,23"H,6 HOLE,SYNERGY,TEXTURED


24" High Canes Standard FRMASMB15842 BACK CANE,ASSY,W/SHORT PUSH HANDLE,24"H,6 HOLE,SYNERGY,TEXTUREDStandard FRMASMB17107 BACK CANE,ASSY,W/SHORT PUSH HANDLE,24"H,SLING,SYNERGY,TEXTURED

$62.50 x 2qty FRMASMB15782 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,24"H,6 HOLE,SYNERGY,TEXTURED25" High Canes Standard FRMASMB15843 BACK CANE,ASSY,W/SHORT PUSH HANDLE,25''H,6 HOLE,SYNERGY,TEXTURED

Standard FRMASMB17108 BACK CANE,ASSY,W/SHORT PUSH HANDLE,25''H,SLING,SYNERGY,TEXTURED$62.50 x 2qty FRMASMB15783 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,25''H,6 HOLE,SYNERGY,TEXTURED

TB-FLEX SEATING SYSTEMTwo-Post, Flip Back, Height Adjustable, Removable Armrests 150 ea. FRMASMB15966 ARMREST,ASSY,ADULT TWO POST FLIP-UP HEIGHT ADJUSTABLE,DESK LENGTH,VERSION 2,W/

SPACERS,SYNERGY,LEFTFRMASMB15967 ARMREST,ASSY,ADULT TWO POST FLIP-UP HEIGHT ADJUSTABLE,DESK LENGTH,VERSION 2,W/

SPACERS,SYNERGY,RIGHTFRMASMB15968 ARMREST,ASSY,ADULT TWO POST FLIP-UP HEIGHT ADJUSTABLE,FULL LENGTH,VERSION 2,W/

SPACERS,SYNERGY,LEFTFRMASMB15969 ARMREST,ASSY,ADULT TWO POST FLIP-UP HEIGHT ADJUSTABLE,FULL LENGTH,VERSION 2,W/

SPACERS,SYNERGY,RIGHTFRMASMB7063 ARMREST,ASSY,ADULT TWO POST FLIP-UP HEIGHT ADJUSTABLE,FULL LENGTH,VERSION

2,RIGHT,SYNERGY,TEXTUREDFRMASMB7062 ARMREST,ASSY,ADULT TWO POST FLIP-UP HEIGHT ADJUSTABLE,FULL LENGTH,VERSION

2,LEFT,SYNERGY,TEXTUREDFRMASMB7061 ARMREST,ASSY,ADULT TWO POST FLIP-UP HEIGHT ADJUSTABLE,DESK LENGTH,VERSION

2,RIGHT,SYNERGY,TEXTUREDFRMASMB7060 ARMREST,ASSY,ADULT TWO POST FLIP-UP HEIGHT ADJUSTABLE,DESK LENGTH,VERSION

2,LEFT,SYNERGY,TEXTURED

SYNERGY SEAT POWER OPTION ELECTRONICSOne Actuator Control through NE+ Joystick $1,895

ELEASMB6575 ELECTRONIC,ASSY,NE+/Q-LOGIC THRU AM1,SYNERGY SEAT,ELEVATE,(CONFIGURATION # 04)

ELEASMB6430ELECTRONIC,ASSY,NE+/Q-LOGIC THRU AM1,SYNERGY SEAT,POWER ARTICULATING FOOT PLATFORM,(CONFIGURATION # 03)

Two Actuator Control through NE+ Joystick $2,375 ELEASMB6039 ELECTRONIC,ASSY,NE PLUS,SYNERGY SEAT,INDEPENDENT LEGS,(CONFIGURATION # 01) ELEASMB6040 ELECTRONIC,ASSY,NE PLUS,SYNERGY SEAT,COMBINED LEGS,(CONFIGURATION # 02)

ELEASMB7161ELECTRONIC,ASSY,NE PLUS,SYNERGY SEAT,ELEVATE/POWER ARTICULATING FOOT PLATFORM,(CONFIGURATION # 07)

One Actuator Control through through Q-Logic 3 Electronics $1,895 ELE167774

ELECTRONIC,ASSY,Q-LOGIC 3/AM1,SYNERGY SEAT,POWER ARTICULATING FOOT PLATFORM,(CONFIGURATION # 03)

ELE1702261 ELECTRONIC,ASSY,Q-LOGIC 3/AM1,SYNERGY SEAT,ELEVATE,(CONFIGURATION # 04)

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ELE167748 ELECTRONIC,ASSY,Q-LOGIC 3/AAM,SYNERGY SEAT,COMBINED LEGS,(CONFIGURATION # 02)

ELE167749ELECTRONIC,ASSY,Q-LOGIC 3/AAM,SYNERGY SEAT,POWER ARTICULATING FOOT PLATFORM,(CONFIGURATION # 03)

ELE1702262 ELECTRONIC,ASSY,Q-LOGIC 3/AAM,SYNERGY SEAT,ELEVATE,(CONFIGURATION # 04) ELE167787 ELECTRONIC,ASSY,Q-LOGIC 3/LAM2,SYNERGY SEAT,POWER ARTICULATING FOOT

PLATFORM,(CONFIGURATION # 03) ELE167788 ELECTRONIC,ASSY,Q-LOGIC 3/LAM2,SYNERGY SEAT,ELEVATE,(CONFIGURATION # 04)

Multiple Actuator Control through Q-Logic 3 Electronics $2,895 ELE167747 ELECTRONIC,ASSY,Q-LOGIC 3/AAM,SYNERGY SEAT,INDEPENDENT LEGS,(CONFIGURATION # 01)

ELE167750ELECTRONIC,ASSY,Q-LOGIC 3/AAM,SYNERGY SEAT,ELEVATE/INDEPENDENT LEGS,(CONFIGURATION # 05)

ELE167751ELECTRONIC,ASSY,Q-LOGIC 3/AAM,SYNERGY SEAT,ELEVATE/COMBINED LEGS,(CONFIGURATION # 06)

ELE167752ELECTRONIC,ASSY,Q-LOGIC 3/AAM,SYNERGY SEAT,ELEVATE/POWER ARTICULATING FOOT PLATFORM,(CONFIGURATION # 07)

LEGRESTS : 60-90 Swing-Away LegrestsP: 11"-13" Length No Charge FRMASMB8053 FOOTREST,ASSY,S/A #8,LOWER EXTENSION,11"-13",C-1010-179P: 11"-13" Length FRMASMB10557 LEGREST,ASSY,LOWER EXTENSION,11"-13",ANGLE ADJUSTABLE,LONG,PAIR

P: 11"-13" Length FRMASMB10558 LEGREST,ASSY,LOWER EXTENSION,11"-13",ANGLE ADJUSTABLE,SHORT,PAIR

L: 11"-13" Length RIG136570 LEGREST,ASSY,S/A #8,LOWER EXTENSION,11"-13",LEFTL: 11"-13" Length FRMASMB10014 LEGREST,ASSY,LOWER EXTENSION,11"-13",ANGLE ADJUSTABLE,LONG,LEFT,E-1010-655L: 11"-13" Length FRMASMB10016 LEGREST,ASSY,LOWER EXTENSION,11"-13",ANGLE ADJUSTABLE,SHORT,LEFT,E-1010-656R: 11"-13" Length RIG136571 LEGREST,ASSY,S/A #8,LOWER EXTENSION,11"-13",RIGHTR: 11"-13" Length FRMASMB10015 LEGREST,ASSY,LOWER EXTENSION,11"-13",ANGLE ADJUSTABLE,LONG,RIGHT,E-1010-657R: 11"-13" Length FRMASMB10017 LEGREST,ASSY,LOWER EXTENSION,11"-13",ANGLE ADJUSTABLE,SHORT,RIGHT,E-1010-658P: 11"-16.5" Length FRMASMB9159 LEGREST,ASSY,MULTI-AXIS LOWER,11"-16.5" EXT,LONG,PAIRP: 11"-16.5" Length FRMASMB9168 LEGREST,ASSY,MULTI-AXIS LOWER,11"-16.5" EXT,SHORT,PAIRL: 11"-16.5" Length FRMASMB9160 LEGREST,ASSY,MULTI-AXIS LOWER,11"-16.5" EXT,LONG,LEFT,E-1010-641L: 11"-16.5" Length FRMASMB9169 LEGREST,ASSY,MULTI-AXIS LOWER,11"-16.5" EXT,SHORT,LEFT,E-1010-642R: 11"-16.5" Length FRMASMB9161 LEGREST,ASSY,MULTI-AXIS LOWER,11"-16.5" EXT,LONG,RIGHT,E-1010-643R: 11"-16.5" Length FRMASMB9170 LEGREST,ASSY,MULTI-AXIS LOWER,11"-16.5" EXT,SHORT,RIGHT,E-1010-644P: 13"-16.5" Length FRMASMB7844 FOOTREST,ASSY,S/A #8,LOWER EXTENSION,13"-16.5",E-1010-415P: 13"-16.5" Length FRMASMB10559 LEGREST,ASSY,LOWER EXTENSION,13"-16.5",ANGLE ADJUSTABLE,LONG,PAIR

P: 13"-16.5" Length FRMASMB10560 LEGREST,ASSY,LOWER EXTENSION,13"-16.5",ANGLE ADJUSTABLE,SHORT,PAIR

L: 13"-16.5" Length RIG133473 LEGREST,ASSY,S/A #8,LOWER EXTENSION,13"-16.5",LEFTL: 13"-16.5" Length FRMASMB10018 LEGREST,ASSY,LOWER EXTENSION,13"-16.5",ANGLE ADJUSTABLE,LONG,LEFT,E-1010-659L: 13"-16.5" Length FRMASMB10020 LEGREST,ASSY,LOWER EXTENSION,13"-16.5",ANGLE ADJUSTABLE,SHORT,LEFT,E-1010-660

R: 13"-16.5" Length RIG133476 LEGREST,ASSY,S/A #8,LOWER EXTENSION,13"-16.5",RIGHTR: 13"-16.5" Length FRMASMB10019 LEGREST,ASSY,LOWER EXTENSION,13"-16.5",ANGLE ADJUSTABLE,LONG,RIGHT,E-1010-661R: 13"-16.5" Length FRMASMB10021 LEGREST,ASSY,LOWER EXTENSION,13"-16.5",ANGLE ADJUSTABLE,SHORT,RIGHT,E-1010-662

P: 15.5"-19.5" Length FRMASMB7845 FOOTREST,ASSY,S/A #8,LOWER EXTENSION,15.5"-19.5",E-1010-381P: 15.5"-19.5" Length FRMASMB10561 LEGREST,ASSY,LOWER EXTENSION,15.5"-19.5",ANGLE ADJUSTABLE,LONG,PAIRP: 15.5"-19.5" Length FRMASMB10562 LEGREST,ASSY,LOWER EXTENSION,15.5"-19.5",ANGLE ADJUSTABLE,SHORT,PAIRP: 15.5"-19.5" Length FRMASMB9162 LEGREST,ASSY,MULTI-AXIS LOWER,15.5"-19.5" EXT,LONG,PAIR

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P: 15.5"-19.5" Length FRMASMB9171 LEGREST,ASSY,MULTI-AXIS LOWER,15.5"-19.5" EXT,SHORT,PAIRL: 15.5"-19.5" Length RIG133474 LEGREST,ASSY,S/A #8,LOWER EXTENSION,15.5"-19.5",LEFTL: 15.5"-19.5" Length FRMASMB10022 LEGREST,ASSY,LOWER EXTENSION,15.5"-19.5",ANGLE ADJUSTABLE,LONG,LEFT,E-1010-663

L: 15.5"-19.5" Length FRMASMB10024 LEGREST,ASSY,LOWER EXTENSION,15.5"-19.5",ANGLE ADJUSTABLE,SHORT,LEFT,E-1010-664

L: 15.5"-19.5" Length FRMASMB9163 LEGREST,ASSY,MULTI-AXIS LOWER,15.5"-19.5" EXT,LONG,LEFT,E-1010-487L: 15.5"-19.5" Length FRMASMB9172 LEGREST,ASSY,MULTI-AXIS LOWER,15.5"-19.5" EXT,SHORT,LEFT,E-1010-645R: 15.5"-19.5" Length RIG133477 LEGREST,ASSY,S/A #8,LOWER EXTENSION,15.5"-19.5",RIGHTR: 15.5"-19.5" Length FRMASMB10023 LEGREST,ASSY,LOWER EXTENSION,15.5"-19.5",ANGLE ADJUSTABLE,LONG,RIGHT,E-1010-665

R: 15.5"-19.5" Length FRMASMB10025 LEGREST,ASSY,LOWER EXTENSION,15.5"-19.5",ANGLE ADJUSTABLE,SHORT,RIGHT,E-1010-666

R: 15.5"-19.5" Length FRMASMB9164 LEGREST,ASSY,MULTI-AXIS LOWER,15.5"-19.5" EXT,LONG,RIGHT,E-1010-488R: 15.5"-19.5" Length FRMASMB9173 LEGREST,ASSY,MULTI-AXIS LOWER,15.5"-19.5" EXT,SHORT,RIGHT,E-1010-646LEGRESTS : 60-90 Swing-Away Legrest AccessoriesWheel Bumper $12.50 ea WHL133585 WHEEL,ASSY,BUMPER,ANGLE ADJUSTABLE FOOTPLATE,LEFT

WHL133587 WHEEL,ASSY,BUMPER,S/A #8 EXTRUDED FOOTPLATE,LEFT WHL169510 WHEEL,ASSY,BUMPER,PEDIATRIC ANGLE ADJUSTABLE FOOTPLATE,LEFTWHL133586 WHEEL,ASSY,BUMPER,ANGLE ADJUSTABLE FOOTPLATE,RIGHT WHL133589 WHEEL,ASSY,BUMPER,S/A #8 EXTRUDED FOOTPLATE,RIGHT WHL169511 WHEEL,ASSY,BUMPER,PEDIATRIC ANGLE ADJUSTABLE FOOTPLATE,RIGHTWHLASMB1578 WHEEL,ASSY,BUMPER,ANGLE ADJUSTABLE FOOTPLATE WHLASMB1727 WHEEL,ASSY,BUMPER,S/A #8 EXTRUDED FOOTPLATE WHL169508 WHEEL,ASSY,BUMPER,PEDIATRIC,ANGLE ADJUSTABLE FOOTPLATE

LEGRESTS : Elevating LegrestsP: 12"-14.5" Length No Charge FRMASMB4752 LEGREST,ASSY,ANGLE ADJUSTABLE LOWER,12"-14.5" EXT,PAIRP: 12"-14.5" Length FRMASMB7922 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,12"-14.5" EXT,FOR SHORT BLOCK,PAIRL: 12"-14.5" Length FRMASMB5391 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,12"-14.5" EXT,LEFT,C-1000-340L: 12"-14.5" Length FRMASMB6279 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,12"-14.5" EXT,FOR SHORT BLOCK,LEFT,C-1000-353

R: 12"-14.5" Length FRMASMB4723 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,12"-14.5" EXT,RIGHT,C-1000-287R: 12"-14.5" Length FRMASMB5136 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,12"-14.5" EXT,FOR SHORT BLOCK,RIGHT,C-1000-318

P: 14.5"-18" Length FRMASMB4753 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,14.5"-18" EXT,PAIRP: 14.5"-18" Length FRMASMB7923 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,14.5"-18" EXT,FOR SHORT BLOCK,PAIRL: 14.5"-18" Length FRMASMB4724 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,14.5"-18" EXT,LEFT,C-1000-288L: 14.5"-18" Length FRMASMB6280 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,14.5"-18" EXT,FOR SHORT BLOCK,LEFT,C-1000-354

R: 14.5" -18" Length FRMASMB5392 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,14.5"-18" EXT,RIGHT,C-1000-341R: 14.5" -18" Length FRMASMB5137 LEGREST,ASSY,ANGLE ADJUSTABLE,LOWER,14.5"-18" EXT,FOR SHORT BLOCK,RIGHT,C-1000-319

LEGRESTS : Elevating Legrest AccessoriesWheel Bumper $12.50 ea WHL133585 WHEEL,ASSY,BUMPER,ANGLE ADJUSTABLE FOOTPLATE,LEFT

WHL133586 WHEEL,ASSY,BUMPER,ANGLE ADJUSTABLE FOOTPLATE,RIGHT WHLASMB1578 WHEEL,ASSY,BUMPER,ANGLE ADJUSTABLE FOOTPLATE WHL169508 WHEEL,ASSY,BUMPER,PEDIATRIC,ANGLE ADJUSTABLE FOOTPLATE

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Documents

Rival Order Form with Contoured, Synergy, and TRU-Balance ... · Rival® Order Form with Contoured, Synergy, and TRU-Balance Flex Seating ... Please see cross-reference spreadsheet