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700 Ensminger Rd., Suite 112, Tonawanda, NY 14150 TOLL FREE TEL: 1.888.433.6818 TOLL FREE FAX: 1.888.433.6834 TRD0532 Rev G PAGE 1 of 12

INVACARE POWER BASES

TDXSP2HD TDX SP2 HD Base for Rehab Seating System

HCPCS code K0850 . . . . . . . . . . . . . . . . . . . . . . . $8,595

TDXSP2HD-CG TDX SP2 HD Base for Single Actuator System

HCPCS code K0858 . . . . . . . . . . . . . . . . . . . . . . . . $8,795

TDXSP2HD-MCG TDX SP2 HD Basefor Multiple Actuator SystemHCPCS code K0862 . . . . . . . . . . . . . . . . . . . . . . . .$8,795

Select STF:

SLOWH 17” LOWH 17.50” MEDH 18.50” TALLH 19.50”

USER WEIGHT LIMITS U350 Weight Capacity up to 350 lbs . . . . . . . . . . . . . . . . . . . STD

U400 Weight Capacity up to 400 lbs . . . . . . . . . . . . . . . . . . . STD

TRANSPORT TIE DOWN TRBKTS Wheelchair Transport Brackets(1) . . . . . . . . . . . . . . . . . . . . STD

1. For unoccupied use only

TIRE OPTIONS B1431-3 14” x 3” Black Tires w/Gel Foam Inserts . . . . . . . . . . . . .STD

B1430-3 14” x 3” Black Tire - Pneumatic . . . . . . . . . . . . . . . . . . N/CFORK OPTIONS

DSFK Double-Sided Fork Package . . . . . . . . . . . . . . . . . . . . . . . .STD

FKPKG Single-Sided Fork Package . . . . . . . . . . . . . . . . . . . . . . . . .$250

BATTERY TRAY TYPE24TRY Group 24 Style Tray - Wide Base 25.5” . . . . . . . . . . . . . . N/C

BATTERY CHARGER OPTION110CHARGER 110 Volt Battery Charger . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/C

L8900 Omit Battery Charger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ($80)

FRAME FINISH163P Black Ice Glossy . . . . . . . . . . . . . . . . . . . . . . . . N/C

162P Space Station Silver . . . . . . . . . . . . . . . . . . . . . . N/C160P Invacare Blue . . . . . . . . . . . . . . . . . . . . . . . N/C

158P Lights Out Black Matte . . . . . . . . . . . . . . . . . . . . N/C

154P Rockstar Red . . . . . . . . . . . . . . . . . . . . . . . N/C

155P Tangy Orange . . . . . . . . . . . . . . . . . . . . . . . . N/C

161P Grape Jelly Bean . . . . . . . . . . . . . . . . . . . . . . . . N/C

157P Island Blue . . . . . . . . . . . . . . . . . . . . . . . . N/C

156P Monster Green . . . . . . . . . . . . . . . . . . . . . . . . N/C

159P White Out . . . . . . . . . . . . . . . . . . . . . . . . N/C

RIM INSERT COLORS - MUST PICK ONE163PR Black Ice Glossy . . . . . . . . . . . . . . . . . . . . . . . N/C

162PR Space Station Silver . . . . . . . . . . . . . . . . . . . . . . N/C160PR Invacare Blue . . . . . . . . . . . . . . . . . . . . . . . N/C

158PR Lights Out Black Matte . . . . . . . . . . . . . . . . . . . . N/C

154PR Rockstar Red . . . . . . . . . . . . . . . . . . . . . . . . N/C

155PR Tangy Orange . . . . . . . . . . . . . . . . . . . . . . . . N/C

161PR Grape Jelly Bean . . . . . . . . . . . . . . . . . . . . . . . . N/C

157PR Island Blue . . . . . . . . . . . . . . . . . . . . . . . . N/C

156PR Monster Green . . . . . . . . . . . . . . . . . . . . . . . . N/C

159PR White Out . . . . . . . . . . . . . . . . . . . . . . . . N/C

Client Height:

Client Weight (lbs):

A. Seat to Shoulder:

B. Trunk Depth:

C. Chest Width:

D. Knee to Back:

E. Seat to Top of Head:

F. Elbow to Hand:

G. Seat to Elbow:

H. Hip Width:

I. Knee to Heel:

Cushion Thickness:

To ensure system is accurately configured please fill in all required

REQUIRED MEASUREMENTSREQUIRED INFORMATION

Ultra Low Maxx Bariatric Power Positioning System for Invacare® TDX® SP2 HD Series

US PRICE LIST AND ORDER FORMPrice Effective July 1, 2020

SMART

SHIP

One cal

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one invoice

RIM INSERTS

Date of Order: __________________ Quote Order Dealer Name: ________________________________________________

Dealer Account #: ___________PO #: ___________________________

Base PO #:___________________________________________________

Tag _________________________________________________________

Purchasing Contact: __________________________________________

Phone: __________________________ Fax: _______________________

E-mail: ______________________________________________________

ATP/Therapist: _______________________________________________

Ship to Address: _____________________________________________

City: ____________________________ State: _____________________

Zip: _____________________________ Client Gender: M F

Special Client Conditions: ____________________________________ Weight Capacity up to 400lbs unless specifi ed otherwise

Customer Service: 1.888.433.6818 I Fax: 1.888.433.6834 I www.motionconcepts.com

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ELECTRONICS

NON-EXPANDABLE SINGLE ACTUATOR JOYSTICKS

REM110S LED Drive Only Remote(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . N/COne drive function, control of single actuator through separate switch

Select switch on page 12 under Single/Dual Function Electronics.

REM210S LED Non-Expandable Remote(1) . . . . . . . . . . . . . . . . . . . . N/C Three drive functions, control of single actuator through the drive control.

REM215S LED Non-Expandable Remote with Lights(2)(3) . . . . . . .$350Three drive functions, control of single actuator through the drive control and

light operation.

1. Not available with lights and indicators.2. Must choose Single/Dual function through drive control, (E2310) separately on page 10 under Single Function Electronics.3. Must choose lighting package separately.

NON-EXPANDABLE DUAL ACTUATOR JOYSTICKS

REM110D LED Drive Only Remote(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . N/COne drive function, control of dual actuator through separate switch.

Select switch on page 10 under Single/Dual Function Electronics.

REM210D LED Non-Expandable Remote(1) . . . . . . . . . . . . . . . . . . . . N/C Three drive functions, control of dual actuators through the drive control.

REM215D LED Non-Expandable Remote with Lights(2)(3) . . . . . . .$350Three drive functions, control of dual actuators through the drive control and lightoperation.

1. Not available with lights and indicators.2. Must choose Single/Dual function through drive control (E2310) separately on . page 10 under Single Function Electronics.3. Must choose lighting package separately.

ELECTRONICS - EXPANDABLE EXPC Expandable Controller HCPCS code E2377 . . . . . .$700

PWH Harness Required for Expandable System . . . . . . . . . $450HCPCS code E2313

GTRAC-LX LiNX G-TRAC Module HCPCS code K0108 . . . . . . . . . . .$995

REM211 LED Expandable Remote(1)(4) . . . . . . . . . . . . . . . . . . . . . . . . N/C Three drive functions, control of up to 6 actuators through the drive control.

Not for use with specialty controls.

REM216 LED Expandable Remote with Lights(2)(4) . . . . . . . . . . .$350 Three drive functions, control of up to 6 actuators through the drive control and light operation. Not for use with specialty controls.

REM400 Color 3.5” Touch Screen Remote(3)(4)(5) . . . . . . . . . . . . $1,000SW400TGL Toggle Kit for REM400(6) . . . . . . . . . . . . . . . . . . . . . .$200

REM500 LiNX Color 3.5” Touch Screen(3)(4) Display Only - No Driver Control, for specialty controls . $1,500

OUTPUT Output Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500

1. Not available with lights and indicators2. Must choose lighting package separately.3. Can control lighting, must choose lightng package separately.4. Must choose PM120AL Expandable Controller and PWH Harness.5. May also be used as display for specialty controls, chose specialty controls separately.6. Adds 2 toggle switches to REM400.

LIGHTS AND INDICATORSLIGHTSLED Lights and Indicators(1) . . . . . . . . . . . . . . . . . . . . . . . . .$700

1. Must order REM215, REM216, REM400 or REM500.

MOUNTING FOR DRIVER CONTROLSMotion Height Adjustable Swing-Away Quad Link

HCPCS code E1028 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$235Select Mounting Position:Left Part # SAQL Right Part # SAQR

ATTENDANT DRIVE CONTROL CHOICESACU Proportional Attendant Control . . . . . . . . . . . . . . . . . . $900

Select Mounting Position:

LeftRight Part # ML MR

SPECIALTY PROPORTIONAL CONTROLS REQUIRES REM400 OR REM500CREM LiNX Compact Remote HCPCS code E2373 ..... $1,500

CREM-LF LiNX Compact Remote Low ForceHCPCS code E2373 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$1,500

LINX* DIGITAL CONTROLS SIP-N-PUFFPKG32666 Therafin Sip-N-Puff Breath Tube Kit . . . . .$380

HCPCS Code E2326

INPUT LiNX Input Module & Sip-N-PuffInterface(1) (9 Pin Connection) . . . . . . . . . . . $1,500HCPCS Code E2325

1. Only one input module per chair.2. Input module also required for any 9-pin specialty control. 9 pin control and Sip-

N-Puff cannot both be used on chair.N-EXLINX ELECTRONIC ACCESSORIESLAK LiNX Access Key(1) . . . . . . . . . . . . . . . . $100

MUSB Motion Dual USB Charger . . . . . . . . . .N/C

1. Required for programming

JOYSTICK TOPS - HCPCS Code E2323

PC101A Bodypoint U Shaped Handle 3”(1) . . .$120PC102A Bodypoint U Shaped Handle 4”(1) . . .$120PC107A Bodypoint Rubber Dome(1) . . . . . . . . . .$1201560 T Handle Flexible

Joystick Extension(1) . . . . . . . . . . . . . . . $1201561 Straight Hangle Flexible

Joystick Extension(1) . . . . . . . . . . . . . . . $1201826 Chin Cup HCPCS Code E2324 . . . . . . . . . . . . $120

1. To remove/disengage the joystick knob from the REM400 Remote pull straight upon the joystick (DO NOT TWIST) otherwise damage may occur and may void thewarranty.

Dealer Name: _______________________________________________

Dealer Account Number: ____________________________________

PO #:_______________________________________________________

Tag: _______________________________________________________

Maxx Bariatric Power Positioning System Base



Dealer Name: _______________________________________________


PO #:_______________________________________________________

Tag: _______________________________________________________

BARIATRIC REHAB SEAT SYSTEM

Maxx Bariatric Rehab Seat -up to 400lbs Part # MBRS . . $2,995

SYSTEMS MUST SELECT ONE SYSTEM

Maxx Bariatric Tilt (50°) Only System - up to 350 lbs Part # MBT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $6,595

Maxx Bariatric Tilt (50°) Only System - 351-400lbsPart # MBT400 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $7,345

Maxx Bariatric Tilt (50°) and Power Recline (150°)System with Extended Shear Reduction (ESR)-up to 350lbsPart # MBTRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $10,795

Maxx Bariatric Tilt (50°) and Power Recline (150°)System with Extended Shear Reduction (ESR)-351-400lbs Part # MBTRE400 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $11,545

Maxx Bariatric Recline Only System (150°) withExtended Shear Reduction (ESR)-up to 350 lbsPart # MBRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $5,995

Maxx Bariatric Recline Only System (150°) withExtended Shear Reduction (ESR) - 351-400lbsPart # MBRE400 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $6,745

MODULES MUST SELECT SYSTEM-TO ADD MODULES

8° Precline Module(1) only available with Recline . . . . . . . N/CPart # PRM8

30° Precline Module(1) only available with Recline . . . . . .$500Part # PRM30

1. Total degrees of recline is 150° ie: if 30° degrees of precline is used, then 120°degrees of recline will be available.

POWER ADJUSTABLE SEAT HEIGHT MODULE

10” Power Adjustable Seat Height Module(1)(2)

HCPCS code E2300 (Scissor Mechanism)Weight Capacity up to 350lbs max. Part # ESM10 . . . . . . . . $2,995

1. Uses an integrated Tilt/Lift mechanism, tilt is 45°.2. Not available with the Maxx Bariatric Rehab Seat or Maxx Bariatric Recline Only

Systems or seat sizes greater than 22” wide by 22” deep.

SEAT SPECIFICATIONSSelect Seat Width and Ultra Rail Width Adjustment

20” 21” 22” 23”24” (Adjustable from 20” - 24” )Part# BW120 BW121 BW122 BW123 BW124

22” 23” 24” 25”26” (Adjustable from 22”- 26”)Part# BW222 BW223 BW224 BW225 BW226

Select Seat Depth and Ultra Rail Depth Adjustment

17”18” 19” 20”21” (Adjustable from 16” - 21”)Part# SD117 SD118 SD119 SD120 SD121 19”20” 21” 22” 23”(Adjustable from 19” - 23”)

Part# SD219 SD220 SD221 SD222 SD223

LAP BELTS AND CHEST STRAPSBP Monoflex, Underarm Release HCPCS code E0960 . . . .$195M(4”x18.25”) Part # MFUM L(4.5”x21.5”) Part # MFUL

BP Monoflex, Centre Release HCPCS code E0960 . . . . . .$195M(4”x18.25”) Part # MFCM L(4.5”x21.5”) Part # MFCL

Push Button Style Seat Belt . . . . . . . . . . . . . . . . . . . . STDPart # 60” BELT60 71”BELT71

Padded Lap Belt 2 point(1) HCPCS code E0978 Part # PLB2 .$190 Padded Lap Belt 4 point(1) HCPCS code E0978 Part # PLB4 . .$235

1. 67” length only option.

CUSHION COVER REFERENCE GUIDE

MATRX SEAT CUSHION OPTIONSMatrx Libra Seat Cushion 20”w

HCPCS Code E2624 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$485

Matrx Libra Seat Cushion 21”wHCPCS Code E2624 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$525

Matrx Libra Seat Cushion 22”-24”wHCPCS Code E2625 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$595

Matrx Libra Adjust Seat Cushion 20”wHCPCS Code E2625 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$625

Matrx Libra Adjust HD Seat Cushion 20”w-21”wHCPCS Code E2624 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$665

Matrx Libra Adjust HD Seat Cushion 20w”-24”wHCPCS Code E2625 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$735

Matrx PS Seat Cushion 20”w - 26”w (weight capacity 600 lbs)HCPCS Code E2605 SelectSmooth Cover Fabric Cover .$695

Matrx Vi Seat Cushion 20”w - 26”w (weight capacity 600 lbs)HCPCS Code E2607 for Sizes 21” w /HCPCS Code E2608 for Sizes 22” w and greater . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$625

”ON-CHAIR” Cushion Credit Part # OCCC . . . . . . . . . ($90)

FABRIC OPTIONS FOR CUSHIONS(1)

Spacetex Fabric Option for Libra/Libra Adjust CushionPart # SFLF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N/C

Infection Control Fabric Option for Libra/Libra Adjust CushionPart # ICFL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50

Startex Fabric Upgrade for Matrx Vi Cushion Smooth Side up Part # SFVS . . . . . . . . . . . . . . . . . . . . . . . . . . . $50 Fabric Side up Part # SFVF . . . . . . . . . . . . . . . . . . . . . . . . . . . . $50

1. Lead time up to 2 weeks

NOTE: Systems Include Seat Pan, Back Pan, Standard Armrests and Front Rigging. They are designed for use with a 2”- 3” cushion.

Infection ControlStartexMeshtex

Spacetex

Cushion Meshtex Startex Infection Spacetex

Libra/Libra Adjust

N/A STD $50 N/C

PS N/A STD -Reversible

STD -Reversible

N/A

Vi STD $50 $50 N/A




MATRX ELAN HEADREST PAD HCPCS code E0955

Matrx Elan Standard Pad . . . . . . . . . . . . . . . . . . . . . . .$235 Part # 6” Pad ESP6 10” Pad ESP10 14” Pad ESP14

Matrx Elan Standard Pad with Infection Control . . .$235Part # 6” Pad ESP6-IC 10” Pad ESP10-IC 14” Pad ESP14-IC

Matrx Elan Occipital Pad . . . . . . . . . . . . . . . . . . . . . . . .$235Part # 9” Pad EOP9 12” Pad EOP12

Matrx Elan Occipital Pad with Infection Control . . . .$235Part # 9” Pad EOP9-IC 12” Pad EOP12-IC

Matrx Elan 4-Point Pad (9”W x 7”H”) . . . . . . . . . . . . .$325Part #Standard Cover E4PTSM Infection Control E4PTSM-IC

Matrx Elan 4-Point Pad (11”W x 10”H”) . . . . . . . . . . .$325Part #Standard Cover E4POINT Infection Control E4POINT-IC

MOTION CONCEPTS HEADREST PAD HCPCS code E0955

Motion Concepts Standard Part # MCSH . . . . . . . . . . . .$295Motion Concepts Auto Style(1) Part # MCOH . . . . . . . . . .$350

1. Comes Standard with Fixed Mounting hardware; for use on Matrx PB or Elite Backs youmust select the removable hardware upgrade below.

HEADREST MOUNTING HARDWARE OPTIONS Fixed Mounting (non-removable)(1)

Part # FM . . . . . . . N/C

Elan Headrest Hardware - Multi-Axis RemovableHCPCS code E1028 Part # MEHW . . . . . . . . . . . . . . . . . . . . . . .$220

Motion Concepts Multi - Axis Removable MountingHCPCS code E1028 Part # MAHU . . . . . . . . . . . . . . . . . . . . . . .$195

OMIT: Headrest Part # OHR . . . . . . . . . . . . . . . . . . . . . . . . . . . N/C

1. Unless selecting a “Removable” hdwr option, the headrest will come standardw/ Fixed Straight Mounting Hardware (non-removable)

FINISHED BACK HEIGHTS (1)

Finished Back heights for Tilt Only Systems(1)(2)

18” 19” 20” 21” 22” 23” 24” 25”Part# FBT18 FBT19 TBT20 FBT21 FBT22 FBT23 FBT24 FBT25

26” 27” Part# FBT26 FBT27

Finished Back heights for Tilt/Recline Systems(3)

19” 20” 21” 22” 23” 24” 25”Part# FBR19 FBR20 FBR21 FBR22 FBR23 FBR24 FBR25

26” 27”Part# FBR26 FBR27

1. Comes with standard cane height.2. 4” gap is recommended for Tilt systems to allow for the seat cushion.3. 6” gap is recommended for systems with Recline/ESR.

TILT ONLY BACK CANE SPECIFICATIONS

Standard Tilt Back CanesMeasured from Seat pan to top of back cane

18” 20” 22” 24” . . . . . . . . . . . . . . . . . N/CPart # SBC18 SBC20 SBC22 SBC24

Select Cane Angle 75° 79° 85° 90° 95° 101° 106° 112° 116°Part # BA75 BA79 BA85 BA90 BA95 BA101 BA106 BA112 BA116

Angled (5°)Tilt Back Canes 20” 22” 24” . . . . . N/CPart # ABC20 ABC22 ABC24

Select Cane Angle 81°84° 91° 96° 101° 106° 111° 117°121°Part # BA81 BA84 BA91 BA96 BA101 BA106 BA111 BA117 BA121

Endomorph Back Canes(1)(2) 22” Part # EBC22 24” Part # EBC24

Select: 1” 2” 4” Narrower . . . . . . . . . .$250Part # EBCN1 EBCN2 EBCN4

10° Mid- Angle Tilt Back Canes(2) . . . . . . . . . . . . . . . . .$250

18” 20” 22” 24” Part # TBC18 TBC20 TBC22 TBC24

1. Comes standard with Cantilever Armrests Cane mounted.2. Quick Height Adjustment on Backrest not available.

BACK OPTIONSStandard Rehab Back and Back cushion Part # SRB

Finished height from 18” to 27” . . . . . . . . . . . . . . . . . . . . . . . N/CAdditional Super Soft/HR Foam for Standard Rehab Back(1) Part # SS . . .$100Matrx Fabric Upcharge Part # MFU . . . . . . . . . . . . . . . . . . . . . . . . . . $100

Planar interface plate(2)(3)

Select one: Flat Part # PIPF Recessed Flat Part # PIPR . . . . $125

OMIT: Rigid Back Pan & Cushion(4) Part # ORBC . . . . . . ($75)OMIT: Back Cushion Only Part # OBC . . . . . . . . . . . . . ($25)

1. Additional foam added may impact seat depth.2. Included with all Recline Systems when no back is selected. May also be used

as an interface for after market backs.3. Not available on tilt only for use with recline module.4. Not available with Recline/ESR.

Dealer Name: _______________________________________________


PO #:_______________________________________________________

Tag: _______________________________________________________




BACK COVER REFERENCE GUIDE

UPGRADABLE BACK OPTIONS

Matrx Elite HD Back 21”- 26” wide (3” Contour). . .$795(Weight capacity is 500lbs)HCPCS Code E2620 (Sizes up to 21” W)/E2621 (Sizes 22” W and greater)

Specify actual back height dimension: 16” 20”

Matrx Elite TR HD Back 21”- 24”wide (3” Contour)(Weight capacity is 500lbs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$845 Specify actual back height dimension: 20”

Matrx Elite Deep HD Back 21”-24” wide (6” Contour) $930(Weight capacity is 500lbs)HCPCS Code E2620 (Sizes up to 21” W)/E2621 (Sizes 22” W and greater)

Specify actual back height dimension: 16” 18” 20”

Matrx PB HD Back 20”- 26”wide (1) (5” Contour) . . . .$835(Weight capacity is 500lbs)HCPCS Code E2615 for 20”w E2616 for 22” W

Specify actual back height dimension: 16”20”

Matrx PB HD Deep Back 20”- 26”wide (1) (7” Contour) . . .$935(Weight capacity is 500lbs ) HCPCS Code E2616Specify actual back height dimension: 16” 20”

”ON-CHAIR” Matrx Back Credit Part # OCBC . . . . . . . . . . . . . . . . . . . . ($125)

1. The Heavy Duty PB Back and PB Deep Back are not available on Recline systems with seat widths of 21” and 22”.

OTHER UPGRADABLE BACK OPTIONS

Super Soft Foam for Elite Back Upgrade Part # EBSS . . . . . . . . .$100

Infection Control Cover for Elite/PB Backs Part ## WSCU . . . . . . .$100(purchased with back)

Infection Control Cover for Elite/PB Backs Part ## WSC. . . . . . . .$150(purchased without back)

TILT ARMRESTS

Adult Dual Post Adjustable Height With Quick HeightAdjustment Lever(pair) . . . . . . . . . . . . . . . . . . . . . . . . . STD

Select Size: (9.75”-12.75”)(12.75”-15.75”)(15.75”-18.75”)Part # DP1 DP2 DP3

Select : Flat pouch Glove BoxesPart # FP GB

Add: OutBack Arm Option(1) (each) Specify:Select: Right Part # OAR Left Part # OAL . . . . . . . . . . . . .$195

(Allows outward rotation while flipping back armrest)

Ultra Rail Mounted Flip Back Cantilever Maxx Tilt . Arm(2)(9”-12”) (pair) Part # RMCAN . . . . . . . . . . . . . . . . . . .$250Add Dual Post Module (pair) Part # DPM . . . . . . . . . . . . . .$250

Cantilever Arms for Endomorph Back Canes Only(see page 2)(pair) Part # CAFEBC . . . . . . . . . . . . . . . . . . . . STD

1. Only available with Dual Post and Recline Adjustable Armrests.2. Mounts to Seat Rail. Slotted upper tube for infinite fore/aft adjustment of arm

pad.

RECLINE ARMRESTS

Reclining Adjustable Height (9.5”-13”) (13”-16”) . . . . STD Part # RC1 RC2

Add: OutBack Arm Option(1) (each) Specify:

Select: Right Part # OAR Left Part # OAL . . . . . . . . . . . .$195 (Allows outward rotation while flipping back armrest)

Outback Cantilever Recline Armrest (pair) . . . . . . . . . . $350Select Range: (9”-12”)(12”-15”)

Part # OCRA1 OCRA2

Cane Mounted Height & Angle Adjustable Cantilever Flip Back Armrest with/Quick Lock Mechanism(2) for Recline Systems (pair) . . . . . . . . . . . . . . . . . . . . . . . $350

Select Range: (9.5”-12”)(10”-13”)(13”-16”) Part # CANQ1 CANQ2 CANQ3

1. Only available with Dual Post and Recline Adjustable Armrests.2. Mounts to Seat Rail. Slotted upper tube for infinite fore/aft adjustment of arm pad.

ARMREST TUBE LENGTH

LEFT Armrest Tube Select: Full Part # ATFLDesk Part # ATDL

RIGHT Armrest Tube Select: Full Part # ATFRDesk Part # ATDR

Dealer Name: _______________________________________________


PO #:_______________________________________________________

Tag: _______________________________________________________

Meshtex Infection Control

Back Meshtex Infection

Elite HD/Elite TR HD STD $100

PB HD/PB HD Deep STD $100




ARM PADS

Modular Arm Pads(1) (each) . . . . . . . . . . . . . . . . . . . . . . .$55Left Full(14”) Part # MAPTFLDesk(10”) Part # MAPTDL

Must select Pad Insert:

Iskin - Integrated soft skin foam Part # ISSFL Startex Covered Visco foam Part # SCVFL

Right Full(14”) Part # MAPTFRDesk(10”) Part # MAPTDR

Must select Pad Insert:

Iskin - Integrated soft skin foam Part # ISSFR Startex Covered Visco foam Part # SCVFR

Standard Pads (each) . . . . . . . . . . . . . . . . . . . . . . . . . . . STDLeft Full(14”)Part # SAPFL Desk(10”) Part # SAPDL

Right Full(14”) Part # SAPFR Desk(10”) Part # SAPDR

Waterfall Arm Pads(2) (each) . . . . . . . . . . . . . . . . . . . . . .$50 Left Full(14”)Part # WAPFL Desk(10”) Part # WAPDL

Right Full(14”) Part # WAPFR Desk(10”) Part # WAPDR

Flat Multi Position Pads (each) . . . . . . . . . . . . . . . . . . . .$55Left Full(14”)Part # MPAFL Desk(10”) Part # MPADL

Right Full(14”) Part # MPAFR Desk(10”) Part # MPADR

Gel Pads (each)Narrow (2”x12”) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$75 Left Part # GAPNL Right Part # GAPNR

Wide (3.5”x12”) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$75 Left Part # GAPWL Right Part # GAPWR

Long (3.5”x14”) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$90

Left Part # GAPLL Right Part # GAPLR

Ergonomic Arm Trough (4.5”x13”) Left Part # EATL HCPCS Code E2209 . . . . . . . . . .$85

Right Part # EATR HCPCS Code E2209 . . . . . . . . . .$85

Flat Hand Pad (4.5”x 5”) - Compatible Only w/Ergonomic Arm Trough

Left Part # FHPL HCPCS Code K0108 . . . . . . . . . . . . . . .$55 Right Part # FHPR HCPCS Code K0108 . . . . . . . . . . . . . . .$55

Arm Pad Storage/Cup Holder(3)

Left Part # APSL . . . . . . . . . . . . . . . . . . . . . . . . . . .$295 Right Part # APSR . . . . . . . . . . . . . . . . . . . . . . . . . .$295

OMIT: Armpads(4) (7/8” diameter tube) Part # OAP. . . . . . . ($25)

1. Requires interchangeable pad insert.2. Full length pad not compatible with the desk length armrest tube if using Ultra

Rail mounted Tilt Arms.3. Only available on Non-Joystick side. Not available on Outback Cantilever

Recline Armrests.4. Must specify the Arm Tube lengths.

ARMPAD ACCESSORIES

Elbow Block LEFT(1) . . . . . . . . . . . . . . . . . . . . . . . . . . . .$195Select Pad Size and Extensions:

XS(3.25”x4.25”) Part # EBXL S(3.5”x5.25”) Part # EBSL

M(3.75”x5.75”) Part # EBML L(4.25”x6.5”) Part # EBLL

Vertical Extension: S(3”) Part # V3 L(5”) Part # V5Horizontal Extension: S(5”) Part # H5 L(7”) Part # H7

Elbow Block RIGHT(1) . . . . . . . . . . . . . . . . . . . . . . . . . .$195Select Pad Size and Extensions:

XS(3.25”x4.25”) Part # EBXR S(3.5”x5.25”) Part # EBSR

M(3.75”x5.75”) Part # EBMR L(4.25”x6.5”) Part # EBLR

Vertical Extension: S(3”) Part # V3 L(5”) Part # V5Horizontal Extension: S(5”) Part # H5 L(7”) Part # H7

Multi Axis Upper Extremity Support(2) (each) . . . . . . . $225With Quick Adjustment Lever

Left Part # MACESL Right Part # MACESR

1” Offset Armrest Spacer (each) . . . . . . . . . . . . . . . . . . . .$125 (Allows seat width to increase by 2” with Dual Post or Recline Arms)

Left Part # OAS2L Right Part # OAS2R

1/2” Offset Armrest Spacer (each) . . . . . . . . . . . . . . . . . . $125 (Allows seat width to increase by 1” with Dual Post or Recline Arms)

Left Part # OAS1L Right Part # OAS1R

Multi Purpose Arm Pad Adapter Block(3) (each)

Quantity (___) Part # MPAPA . . . . . . . . . . . . . . . . . . . . $35

1. Prevents arm from slipping.2. Allows rotation of the armpad, only compatible with Gel pad, Flat pad or Ergo- nomic Arm Troughs.3. Not available with Standard Pads or Waterfall Pads.

Dealer Name: _______________________________________________


PO #:_______________________________________________________

Tag: _______________________________________________________




MAXX LATERALS PADS (1)

Fixed Mounted Lateral Trunk Support LEFT . . . . . . . .$100HCPCS code E0956

Select Pad Size:

XS(3.25”x4.25”) Part # LATXL S(3.5”x5.25”) Part # LATSL

M(3.75”x5.75”) Part # LATML L(4.25”x6.5”) Part # LATLL

Fixed Mounted Lateral Trunk Support RIGHT . . . . . .$100HCPCS code E0956

Select Pad Size:

XS(3.25”x4.25”) Part # LATXR S(3.5”x5.25”) Part # LATSR

M(3.75”x5.75”) Part # LATMR L(4.25”x6.5”) Part # LATLR

SELECT SWING AWAY HARDWARE TO CONVERT ABOVE SUPPORTS:

Maxx Style Swing-away Multi-Adjustable Mounting Hardware LEFT HCPCS code E1028 Part # SALATL . . . . . . .$195

(Standard with 1” telescoping link gives 0-2.75” medial offset (2))

Maxx Style Swing-away Multi-Adjustable Mounting Hardware RIGHT HCPCS code E1028 Part # SALATR . . . . . .$195

(Standard with 1” telescoping link gives 0-2.75” medial offset (2))

Additional Telescoping Link(ea) Quantity ( ) . . . . .$75(Adding an additional 1” telescoping link gives up to 5.5” medial offset(2))

LEFT Part # ATLL RIGHT Part # ATLR

1. These laterals are not available with Matrx PB, PB Elite Deep and PB DeepBacks.

2. The amount of offset available may be impacted by back thickness.

MATRX FIXED LATERALS - FOR ELITE AND ELITE TR BACKS

Matrx Standard Fixed LEFT HCPCS code E0956 . . . . . . . . . .$100Select pad: Standard (7.5” x 5”) Part # PBLSL

Small (5.5” x 3”) Part # PBSSL

Matrx Standard Fixed RIGHT HCPCS code E0956 . . . . . . . .$100Select pad: Standard (7.5” x 5”) Part # PBLSR

Small (5.5” x 3”) Part # PBSSR

Matrx Offset Fixed LEFT HCPCS code E0956 Part # PBOLL .$110

Matrx Offset Fixed RIGHT HCPCS code E0956 Part # PBOLR $110

MATRX SWING AWAY LATERALS - FOR ELITE AND ELITE TR BACKS

Matrx Lateral Trunk Support LEFT pad (each) . . . . .$100HCPCS code E0956

Select Pad Size:

XS(3.25”x4.25”) Part # EPADXL S(3.5”x5.25”) Part # EPADSL

M(3.75”x5.75”) Part # EPADML L(4.25”x6.5”) Part # EPADLL

Matrx Lateral Trunk Support RIGHT pad (each) . . . .$100HCPCS code E0956

Select Pad Size:

XS(3.25”x4.25”) Part # EPADXR S(3.5”x5.25”) Part # EPADSR

M(3.75”x5.75”) Part # EPADMR L(4.25”x6.5”) Part # EPADLR

SELECT SWING AWAY HARDWARE TO CONVERT ABOVE:

Matrx Elite Back Swing Away Hardware LEFT HCPCS code E1028 Part # SAHEBL . . . . . . . . . $195

RIGHT HCPCS code E1028 Part # SAHEBR . . . . . . . . $195

Matrx Offset Elite Swing Away HardwareLEFT HCPCS code E1028 Part # OSAHL . . . . . . . . . . $195

RIGHT HCPCS code E1028 Part # OSAHR . . . . . . . . . $195

Dealer Name: _______________________________________________


PO #:_______________________________________________________

Tag: _______________________________________________________




FIXED HIP/KNEE SUPPORTS

Lateral Hip Support Pad with Fixed Mounting LEFT .$120HCPCS code E0956Mounted at HIP Pad Size:XS(5.5”W x 4”H) Part # HSPXLH S(7”W x 6”H) Part # HSPSLH

M(9”W x 4”H) Part # HSPMLH L(13”W x 4”H) Part # HSPLLH

Mounted at KNEE Pad Size:XS(5.5”W x 4”H) Part # HSPXLK S(7”W x 6”H) Part # HSPSLK

M(9”W x 4”H) Part # HSPMLK L(13”W x 4”H) Part # HSPLLK

Lateral Hip Support Pad with Fixed Mounting RIGHT . . $120HCPCS code E0956

Mounted at HIP Pad Size:XS(5.5”W x 4”H) Part # HSPXRH S(7”W x 6”H) Part # HSPSRH

M(9”W x 4”H) Part # HSPMRH L(13”W x 4”H) Part # HSPLRH

Mounted at KNEE Pad Size:XS(5.5”W x 4”H) Part # HSPXRK S(7”W x 6”H) Part # HSPSRK

M(9”W x 4”H) Part # HSPMRK L(13”W x 4”H) Part # HSPLRK

REMOVABLE & SWING AWAY HARDWARE UPGRADE

Lift Off Removable Hardware for Hip Support (Hip position only) HCPCS code E1028

LEFT Part # LOHL . . . . . . . . . . . . . . . . . . . . . .$195 RIGHT Part # LOHR . . . . . . . . . . . . . . . . . . . . . .$195

Swing Away Removable Hardware for Hip Supports HCPCS code E1028

LEFT Mounted at Hip Part # SHSHLH . . . . . . . . .$215 RIGHT Mounted at Hip Part # SHSHRH . . . . . . . . .$215

LEFT Mounted at Knee Part # SHSHLK . . . . . . . .$215 RIGHT Mounted at Knee Part # SHSHRK . . . . . . . .$215

Maxx Style Quick Release, Removable, Multi-AxisMounting Hardware for Hip Supports HCPCS code E1028

LEFT Mounted at Hip Part # MHSHLH . . . . . . . . .$215 RIGHT Mounted at Hip Part # MHSHRH . . . . . . . . .$215

LEFT Mounted at Knee Part # MHSHLK . . . . . . . .$215 RIGHT Mounted at Knee Part # MHSHRK . . . . . . . .$215

Extended Maxx Style Quick Release, Removable, Multi-AxisMounting Hardware for Hip Supports(1) HCPCS code E1028

LEFT Mounted at Hip Part # EMQHLH . . . . . . . . .$215 RIGHT Mounted at Hip Part # EMQHRH . . . . . . . .$215

LEFT Mounted at Knee Part # EMQHLK . . . . . . . .$215 RIGHT Mounted at Knee Part # EMQHRK . . . . . . . .$215

1. Recomended when finished seat cushion thickness will be greater then 3.5”

high.

STANDARD FRONT RIGGING

Fixed Center Mount Foot Platform(1) Part # FCMP . . . . . . . . N/C Comes with a rubber coated footplate 11½” W x 10” Part # IFP

Set at70° 90° 97° Part # SA70 SA90 SA97

Seat pan to footplate: 9”-13” Part # SPTF1 13”-19” Part # SPTF14

1. 3” ground clearance required.

POWER CENTER MOUNT FOOT PLATFORM OPTIONS

LNX Power Center Mount Foot Platform(1)(2)

Part # LNX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $2,995HCPCS code E1012 13”-19” unlimited adjustability . . . . . . . . . . . . . N/CComes standard with a rubber coated footplate 11½” W x 10” Part # IFP

Comes standard with individual calf pads Part # ICP

Add: One Piece Malleable Calf Panel Part # OPCP . . . . . . . .$250

1. There is 8” of anti-shear extension.2. 2 1/2” of ground clearance required.

MANUAL CENTER MOUNT FRONT RIGGING

Maxx Style Fixed Center Mount Foot Platform(1)(2)

Part # MSFCMFP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $395Comes standard with a rubber coated footplate 11½” W x 10” Part # IFP

Comes standard with individual calf pads Part # ICP

Set at70° 90°97°

Part # SA70 SA90 SA97

Seat pan to footplate: 9”-13” Part # SPTF1Seat pan to footplate: 13”-19” Part # SPTF14

1. Depth and height adjustable.2. 3” ground clearance required.

Dealer Name: _______________________________________________


PO #:_______________________________________________________

Tag: _______________________________________________________

MUST BE COMPLETED Measurement in Inches

Knee to Heel:

Cushion Thickness: (Subtract)

Cushion Compression:(Add)

Seat Pan to Footplate:(Total)




FOOT PLATFORM OPTIONS FOR FIXED CENTER MOUNTS AND LNX CMFP

Small Flip-up Foot Platform(1) . . . . . .$180 (12”W x 8.5”D) Part # SFFP

Medium Flip-up Foot Platform(1) . . . .$180(12”W x 10.75”D) Part # MFFP

Large Flip-up Foot Platform(1) . . . . . .$250 (14.5”W x 13”D) Part # LFFP

Extra Large Flip-up Foot Platform(1) .$250(17”W x 13”D) Part # XLFFP

Extra, Extra Large Flip-up Foot Platform(1) $250(21”W x 13”D) Part # XXLFFP

Multi-Axis Individual Foot plate Right . $225(6”W x 10”D) Part # MFOR

Multi-Axis Individual Foot plate Left . $225(6”W x 10”D) Part # MFOL

1. May cause interference with certain bases and seat widths call to confirm con-figuration.

INDIVIDUAL FOOT PLATE OPTIONS FOR FIXEDCENTER MOUNTS AND LNX CMFPIn cast aluminum with built in heel cups and rubber mat

Left: S(5”W x 7.5”D) M(5.5”Wx9.5”D)L(6”Wx11.5”D) $165Part # IFSL IFML IFLL

Right: S(5”W x 7.5”D) M(5.5”Wx9.5”D)L(6”Wx11.5”D) $165Part # IFSR IFMR IFLR

POWER FRONT RIGGING OPTIONS(1)

Maxx Style Swing-Away Power Elevating Pivot Legrests(2) HCPCS code E1010 Part # MSPPL . . . . . $2,490

Select Receivers: Straight Flared outward 1”Part # RS Part # RF

Seat pan to footplate: S (10”-14”) M (13”-17”) L (16”-20”) Part # SPTF5 SPTF2 SPTF7

Select Function: Individual(3) Combined Synchronized W/ReclinePart # INDA COMA SYNA

Calf pad options (Pair) . . . . . . . . . . . . . . . . . . . . $275Select: Flat Pads Part # FCPMS

Curved Calf pads (inside width is 6”) Part # CCPMS

1. Comes standard with moulded i-skin calf pads.2. Includes Swing Away receivers, Pivot Plus Legrests and actuators. Legs swing

away manually.3. Individual legs count as two functions.

Select Footplates on page 10 Foot plate options:

MANUAL FRONT RIGGING OPTIONS(1)

Maxx Style Swing-Away Manual Elevating Pivot Legrests Part # MMPPSA . . . . . . . . . . . . . . . . . . . . .$680

Select Receivers: Straight Flared outward 1”Part # RS Part # RF

Seat pan to footplate: S (10”-14”) M (13”-17”) L (16”-20”)Part # SPTF5 SPTF2 SPTF7

Calf pad options (Pair) . . . . . . . . . . . . . . . . . . . . . . .$275Select: Flat Pads Part # FCPMS

Curved Calf pads (inside width is 6”) Part # CCPMS

1. Comes standard with moulded i-skin calf pads.

Select Footplates on page 10 Foot plate options:

SWING AWAY FRONT RIGGING OPTIONS

Heavy Duty 70° Swing away Footrests(1) (Pair) . . . .$495Part # HD70

Select Receivers: Straight Flared outward1”Part # RS Part # RF

Seat pan to footplate:

XS (6”-11”) S (11”-15”) M (13”-17”)L (16”-20”) Part # SPTF11 SPTF8 SPTF2 SPTF7

Calf pads for HD Swing Away Footrests (Pair) . . .$275Select: Flat Pads Part # HD70FCP

Curved Calf pads (inside width is 6”) Part # HD70CCP

1. Heavy duty durable construction (4.5lbs ea.).

Select Footplates on page 10 under Foot plate options:

Dealer Name: _______________________________________________


PO #:_______________________________________________________

Tag: _______________________________________________________




FOOT PLATE OPTIONS FOR ELEVATING &SWING AWAY FRONT RIGGING (1)

SELECT FOOTPLATE SIZE FOR BELOW HARDWARE:

Adjustable Angle Foot Plates (each)HCPCS code K0040 . . . . . . .$165LEFT S(4.25”W x 8”D)M(5.25”Wx8”D)L(6.25”Wx8”D)XL(9”Wx11”D)

Part # AFSL AFML AFLL AFXL

RIGHT S(4.25”W x 8”D)M(5.25”Wx8”D)L(6.25”Wx8”D)XL(9”Wx11”D)Part # AFSR AFMR AFLR AFXR

Multi-Axis Adjustable Angle Foot Plates(each)HCPCS code K0040 $225LEFT S(4.25”W x 8”D)M(5.25”Wx8”D)L(6.25”Wx8”D)XL(9”Wx11”D)Part # MFSL MFML MFLL MFXL

RIGHTS(4.25”W x 8”D)M(5.25”Wx8”D)L(6.25”Wx8”D)XL(9”Wx11”D)

Part # MFSR MFMR MFLR MFXR

Adjustable Angle Foot Plates/Cut Outs (each)HCPCS code K0040 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$165LEFT S(7.25”W x 9”D) M(7.5”W x 11”D) L(10”W x 14”D)

Part # AFCSL AFCML AFCLL

RIGHT S(7.25”W x 9”D) M(7.5”W x 11”D) L(10”W x 14”D)Part # AFCSR AFCMR AFCLR

Multi-Axis Adjustable Angle Foot Plates/Cut Out(each)HCPCS code K0040 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$225LEFT S(7.25”W x 9”D) M(7.5”W x 11”D) L(10”W x 14”D)

Part # MFCSL MFCML MFCLL

RIGHT S(7.25”W x 9”D) M(7.5”W x 11”D) L(10”W x 14”D)Part # MFCSR MFCMR MFCLR

HEEL LOOPS, CUPS AND TOE STRAPSHeel Loops (each)HCPCS code E0951 . . . . . . . . . . . . . . . . . . . . .$20

Left Part # HLLRight Part # HLR

Heel Cups (each)HCPCS code E0951 . . . . . . . . . . . . . . . . . . . . .$20 Left Part # HCLRight Part # HCR

Toe Strap (each)HCPCS code E0952. . . . . . . . . . . . . . . . . . . . . .$20 Left Part # TSLRight Part # TSR

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CALF PANEL & STRAP OPTIONS(1)

Airmesh Calf Strap for chairs 20”-22”W - 3.5” pad . . . height Part # CSL . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$150

Airmesh Calf Panel for chairs 20”-22”W;38.5”W x 9”H pad Part # CPL . . . . . . . . . . . . . . . . . . .$235

1. Not available for Center Mounted Front Rigging.

SINGLE-FUNCTION ELECTRONICS

Select: LeftRightDo Not MountPart # ESML ESMR ESMD

SINGLE-DUAL FUNCTION ELECTRONICS

Single/Dual Function Through Switch/Toggle(1)

Part # SFCB . . . . . . . . . . . . . . . . . . . . . . . . . . . . STDPlease Select One: Single Push Button Part # SPBSO

Single Toggle Part # STO

Dual Push Button Part # DPBO

Omit Switch Part # OSOAdd: Reduced Drive for Elevating Seat(2) Part # RDE . . . . . . . .$400

Single/Dual Function Drive Control(1)(2) Part # SFCBA $1,795 HCPCS code E2310

Through Joystick Part # JOY

Through Specialty Control Part # SC

Add: Reduced Drive for Elevating Seat(3) Part # RDE . . . . . . . .$400

Additional Switch: Single Push Button Part # SPBSA . . . . .$97 Single Toggle Part # STA

Dual Push Button Part # DPBA

1. These electronics include drive lock-out and tilt limit.2. Toggle action only.3. If reduced drive is not selected system will be in drive lock-out when elevated.

MULTI-FUNCTION ELECTRONICSMulti Function Through Switches/Toggles(1)

Part # MFCBS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,145Select: Quad Push Button Part # QPBO

Four-Way Toggle Part # FWTO

8-Way Rocker(2) Part # EWRO

Add: Reduced Drive for Elevating Seat (3) Part # RDE . . . . . . . .$400

Multi Function Through Drive Control(1) Part # MFCBD $2,995HCPCS code E2311

Through Joystick Part # JOY

Through Specialty Control Part # SC

Includes:Reduced Drive for Elevating Seat Yes Part # RDY

No(3) Part # RDN Additional Switch: Quad Push Button Part # QPBA ..................$97 Four-Way Toggle Part # FWTA ...................$97 8-Way Rocker(2) Part # EWRA ....................$150

1. These electronics include attendant control, drive lock-out, tilt/recline limit andactuator speed control.

2. Dual function is not available with 8-Way Rocker.3. If reduced drive is not selected system will be in drive lock-out when elevated.

Dealer Name: _______________________________________________


PO #:_______________________________________________________

Tag: _______________________________________________________




ELECTRONICS OPTIONS M616 Splitter Part # M616S . . . . . . . . . . . . . . . . . . . . . .$125

(Allows for multiple switch options with phono plug connection)

Feather Touch Switch - Single function . . . . . . . . . . . . . . . . .$295 Quarter Size Part # FTSQ

Feather Touch Switch - Multi function . . . . . . . . . . . . . . . . .$295 Dual Dime Size Part # FTMD Quad Dime Size Part # FTMQ

Stealth Egg Switch-Single function . . . . . . . . . . . . . . . . . . .$77 Green Part # SESG Black Part # SESB

Lazarus Jump Starter Part # LJS . . . . . . . . . . . . . . . . .$150Accessory Port Power Supply (3 amp capacity) Part # APPS . .$195

12 Piece Switch Mounting Hardware Kit Part # TPSMH . .$39(additional kits)

O2 HOLDERS(1)

Non-Articulating O2 Gas Holder Part # NAO2H . . . . . . $395(Cylinder Style)

Articulating O2 Gas Holder(2)(3) . . . . . . . . . . . . . . . . $1,250Select:

O2 Gas (Cylinder Style) Part # AOHG

Liquid O2 (6.5” x 4.5”) Part # AOHL

1. The user weight limit is 325lbs and the maximum weight capacity of the O2holder is 20lbs.

2. Articulating O2 holders are not standard configurations on Precline System,please call for quotation.

3. Required for use on Recline Systems.

ADDITIONAL OPTIONS & ACCESSORIESTransfer Handles (Height Adjustable) . . . . . . . . . . . . . . . .$350 Select: 4”-6.5” Part # THS 9”-11.5” Part # THL

Push Handles for Recline Systems(1) . . . . . . . . . . . . . .$350 Select: Straight Part # RPHS Angled Part # RPHA

1. 4” of total vertical mounting adjustment.

BATTERIESMK GROUP 24 Battery (Each)Quantity ( ) Part # M24 SLD G HCPCS code E2363. . . . . . . . . . . . . .$365

INSTALLATION Installation by Motion Concepts Part # MBI . . . . . . . . . N/C

Total Retail Value $

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Dealer Name: _______________________________________________


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Current weight:

Weight history: __________________________________________________________

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1. Back of knee /calf to back of buttocks (seat pan depth)

2. Back of knee/calf to thoracic-lumber trunk (for seat depth):

3. Seat pan to under forearm (armrest height):

4. Seat pan to top of gluteal tissue (lower aspectof back support height):

5. Width at toes (lateral aspect):

6. Width from lateral calf to lateral calf (at widest aspect):

7. Overall hip width:

8. Lateral elbow to lateral elbow:

9. Back of head scapula:

To ensure system is accurately configured please fill in all required measurements.

ADDITIONAL MEASUREMENTS FOR BARIATRIC CLIENTS

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ADDITIONAL NOTES


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