q6 edge z order form with tru-balance 3 positioning aadl ... · q6 edge® z order form with...

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Q6 Edge® Z Order Form with TRU-Balance® 3 Positioning AADL W659/W991

This form is interactive when viewed with Adobe Acrobat Reader. Complete 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 at-tach 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. Other part numbers can be found on the quote ac-knowledgment after this order form is submitted. Please contact Quantum® Sales at 888-570-1113 if assistance is needed. Send the completed order form by fax (866-514-1303) 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 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.

Pride Mobility Products Co. FOR AADL USE ONLY5096 South Service Rd, Beamsville, ON, L0R 1B3Phone: 888-570-1113 | Fax: 866-514-1303 | Email: [email protected]

Account Number: ___________ Date: ________________

Provider Name: __________________________________

Contact: ________________________________________

Phone: ___________________ Fax: _________________

Email: __________________________________________

PO Number: _____________________________________

Marked for: _____________________________________

Ship to Address: _________________________________

City: _____________________ Prov: ______ PC: ______

Weight:________ Height:________

PATIENT INFORMATION

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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: ________

INTRODUCTION

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Quantum Q6 Edge Z .......................................... $8,080

BASE MOUNTED FOOT PLATFORMREQUIRED. Select a foot platform option. May interfere with seat mounted legrests.

Base Mounted Foot Platform .............................StandardNot available with center mount foot platforms.

Omit base mounted foot platform .................... No Charge

DRIVE WHEELSREQUIRED. Select a type of drive wheels. Knobby tires increase overall base width by 1.5”. Standard battery and accessory pricing applies.

14” Run Flat Tires ..........................................Standard

14” Pneumatic Tires ..................................... No Charge

4”W Flat Free, Knobby, Extended Traction Tires ........ $120

4”W Pneumatic, Knobby, Extended ......................... $120

Standard, 6mph Motor Package .........................Standard

High Speed Motor Package .................................... $160Programmable speed up to 8 mph. High speed motors decrease per-charge range. Not available with iLevel seating. Not covered by AADL

Accu-Trac Motor Technology .................................. $630

Requires Q-Logic 2 electronics. Delivers enhanced traction and track-ing, especially with switched drive controls. Programmable speed up to 6 mph.

DRIVE MOTORSREQUIRED.

BASE COLORREQUIRED. Select one shroud color. Colors shown here may differ from actual product depending on monitor/printer calibration used.

Fender Lights through Single Switch ................................................................................$240Fender lights that operate only by pressing included single switch button. No charge when chosen with iLevel.

BASE LIGHTING PACKAGESOptional. Select one type of optional lighting packages below. Lighting is not available with Single Actuator Control through Toggle Box. Stan-dard battery and accessory pricing applies. Not covered by AADL

BASE MODELREQUIRED. Select a power base. 300 lb. weight capacity with standard 6mph programmable motors, 8 amp off board charger, and switch oper-ated fender lights. Dimensions of base without legrests: 26.25”Wx35.5”L.

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

NE+ 6-Key Joystick ......................... StandardControl up to 2 actuators through joystick.

No Joystick, Setup for NE+ Joystick ... No Charge

NE+ 8-Key Joystick ........................ No ChargeControl up to 2 actuators and Seat Mounted LED Light Package through joystick.

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.

Fender Lights

Rim Colour Accent Options

Standard Rims ...............................................Standard

Other Colour Options Not covered by AADL...................$85Select colour below, other colour options N/A on knobby tires.

Back in Black

Midnight Blue

Back in BlackPart: DGN150343-PBK1

Midnight BluePart: DGN150343-PBU10


Q-Logic 3 EX Joystick ............................ $900

Q-Logic 3 Ex Joystick for Seat ................. $900Mounted, LED Light Package

No Joystick, Setup for Q-Logic

Q-Logic 3 Joystick

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

Back in Black

Midnight Blue

Black, Soft Touch ............................ Standard

Non-matching Joystick Shroud .................. $75Select color below. Not covered by AADL

Match Joystick Shroud to Base Color ........... $75Not covered by AADL

Expandable ControlsSelect expandable controls or omit selection if another controller type is desired. Expandable controls allow multiple or specialized controllers.

JOYSTICK HANDLESOptional. 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. Standard battery and accessory pricing applies.

Mushroom Handle (B) .............................$120Part: ACCASMB1860

Chin Cup (C) ......................................... $90Part: ACCASMB1861

T-Bar (D) .............................................$160Part: ACCASMB1858

Medium Ball Handle (E) ............................ $70Part: ACCASMB1859

Soft Ball Handle (F) ................................$120Part: ACCASMB1856

Extended I-Handle (G) ............................$140Part: ACCASMB1857

3” Goal Post Handle ...............................$180Part: PLSKNCP1057

4” Goal Post Handle ...............................$180Part: PLSKNCP1058

ELECTRONICS continued

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

Fixed, Inline, Left Side Mount ............ Standard Fixed, Inline, Right Side Mount ........... Standard

Omit Joystick Mounting Bracket or See Positioning Positioning Components Page or order form.

Fixed, Inline Joystick Bracket

Swing-Away (Retractable) BracketAllows the joystick to retract to the side of the armrest while maintaining the same joystick orientation. "Inline brack-et" is used with TRU-Balance 3 arms when the joystick is inline with armpad. "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.

Swing-away, Inline, Left Side Mount .......... $265NE/NE+ Part: ACC142526 Q-Logic: ACC142524

Swing-away, Inline, Right Side Mount ........ $265NE/NE+ Part: ACC142527 Q-Logic: ACC142525

Swing-away, 1” Offset, Left Side Mount ..... $265NE/NE+ Part: ACC142747 Q-Logic: ACC142742

Swing-away, 1” Offset, Right Side Mount .... $265NE/NE+ Part: ACC142748 Q-Logic: ACC142743


Multi-axis, Left Side Mount ......................$100NE/NE+ Part: ACC142528 Q-Logic: ACC131216

Multi-axis, Right Side Mount ....................$100NE/NE+ Part: ACC142528 Q-Logic: ACC131216

Retract4, Left Side Mount ...................... $450NE/NE+ Part: MEC138876 Q-Logic: MEC138860

Retract4, Right Side Mount ..................... $450NE/NE+ Part: MEC138876 Q-Logic: MEC138860

Multi-AxisAllows height adjustment of joystick.

Stealth Swing Away/Flip Down BracketAllows the joystick to pivot to side of armrest, or flip-down if bracket is adjusted. Standard Stealth pricing applies.

ELECTRONICS ACCESSORIESOptional. Standard battery and accessory pricing applies. Not covered by AADL.

USB Mobile Device Charger ......................$185Can charge 1 device. A multiplier harness is required and must be added when a Static Seat or Power Tilt Only seating system is chosen. The selection of more than 3 modules requires an additional multiplier.

TRU-BALANCE® 3 SEATINGREQUIRED. Select one seating system. Be sure to complete the Seat Dimension, Seat to Floor, and back selections.

TRU-Balance® 3 Configuration

TRU-Balance 3 12” Power Lift with iLevel® ..............$2,495Part: PTOINDV3773 Not covered by AADL Not available with high speed motors or manual recline. A control type in Power Positioning Electronics section, page 8, must be selected.

Attendant Manual Recline* .................................... $790Part: PTOINDV3501 *Available through Special Order. Not available with NE+ joystick with Tilt through toggle. Available with Static Seat or Power Tilt. Not avail-able with Power Lift.

12” Power Lift or Manual ReclineOptional. Select one option below.

JOYSTICK MOUNTING BRACKETS continued

WC-19 Occupied Transit Option.....................................................................................................................$400To determine if your chair is WC-19 compliant (occupied), please refer to this website: http://www.rercwts.org.

Occupied Transit KitOptional. The Q6 Edge Z is standard with Unoccupied Transit Loops. 60” Sure-Lok Lap Belt is required with Occupied Transit Option.

WC-19 Occupied Transit Option.................................................................................................................... $400To determine if your chair is WC-19 compliant (occupied), please refer to this website: http://wc-transportation-safety.umtri.umich.edu/crash-tested-product-lists/wheelchairs

Retract4 Swing-Away Arm KitFull 180° of movement that translates into multi-position use, straight, right offset, left offset, or fold away. Joystick orientation varies as bracket is adjusted.

Stealth Swing-Away/Flip Down Bracket ...... $300Left Side Mount

Stand Alone Part: ST-TWBM480CJ-Q Q-Logic Part: ST-TWBM480QL-Q

Stealth Swing-Away/Flip Down Bracket ...... $300Right Side Mount

Stand Alone Part: ST-TWBM480CJ-Q Q-Logic Part: ST-TWBM480QL-Q

TRU-Balance® 3 Static Seat ..................................$1,04520° of limited recline adjustment (-5/ +15) via gas strut within back cover.

TRU-Balance® 3 Power Tilt ..................................$7,555Part: PTOINDV3443 50° Center of Gravity (CG) power tilt seating system.

TRU-Balance® 3 Power Recline .............................$7,875Part: PTOINDV3444 175° of power recline.

TRU-Balance® 3 Power Tilt & Recline ....................$13,125Part: PTOINDV3446 50° CG power tilt with 175° of power recline. Full drive lockout at 20°.

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WC19 Occupied is new. Comes stardard with unoccupied transit loops


Seat DimensionsREQUIRED with seat selection. Select width and depth package and enter desired set width and depth in that package range, available in 1” increments. Configurations disallowed or not shown may be available through special order. Maximum seat size is 24"W x 24"D.

Set Width at:______ (Max seat width is 24")

Set Depth at:______ (Max seat width is 24")

Seat to Floor HeightREQUIRED. Select a seat to floor height compatible with the seat functions previously selected.

Back SelectionREQUIRED. Match choice in this section with the options in the back cushion configuration section. First MSRP is for Static Seat, second for Power Positioning.

Angle Adjustable ............................................Standard

Flip Forward ............................................... No Charge

1” Endo ..................................................... No Charge

2” Endo ..................................................... No Charge

Static Back .......................................... $735/Standard**Standard with Power Positioning. Select a back cushion configura-tion in the subsequent section.

Back Cane Option, Omit ........................Standard/(-$735)*Back Pan/ CushionStandard on Static Seat and -$735 on Power Tilt Only. Select cane type and the back cane height below.

Flip Forward Back ........................................ $760/$25*Available with Static Seat ($760) and Power Tilt only ($25). Only avail-able with 2-post, flip back or pediatric armrests. Not available with 12”-14” width or with attendant manual recline. Select a back cushion type in the subsequent section.

Back CaneSelect with Back Cane Option selected above.

TRU-BALANCE® 3 SEATING continued

Back Cane HeightSelect with Back Cane Option selected above.

16” 17” 20” 21” 24” 25”

Back Cushion ConfigurationREQUIRED except when back cane option selected. Select a configuration type and applicable dimensions. See the Sport, Q-Back, 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. Standard ADI pricing applies.

12”-16” Depth Package 14”-16” Depth Package 16”-20” Depth Package 20”-24” Depth Package

Static Seat or Recline Only

Tilt Only/Tilt and Recline/Power Lift

16.5” Seat to Floor 17.5” Seat to Floor 18.5” Seat to Floor

18.5” Seat to Floor 19.5” Seat to Floor 20.5” Seat to Floor

Seat Depth

Seat Width

12”-16” Width PackageOnly available with 12-16" Depth Package. AFP/Center Mount N/A when this option is selected.

14”-16” Width Package 16”-20” Width Package 20”-24” Width Package

Sport Back.................................................. No ChargeComplete following width package and size.

Omit Back Pan/Cushion .................................. No ChargeSelect a following width package.

Aftermarket Back Interface ............................ No ChargeEnter the preset back width below. Overall seat depth may need to be adjusted to accommodate certain backs. May interfere with gel/wa-terfall armpads and arm through. Does not include brackets to mount aftermarket backs. A Special Order is required on back widths less than 16”.


TRU-Balance 3 Flip-Back, 8”-12”H ...................... $145**No charge with Power Positioning

TRU-Balance 3 Flip-Back, 12”-16”H .................... $145**No charge with Power Positioning

Match Seat Width Selections

10”W-14”W Package



Back Cushion Overall HeightStatic Seat and Power Tilt available height range: 16”-25”H. Odd heights include 4” gap and even heights include 3” gap between seat pan and bottom of back cushion. Power Recline available height range: 19”-28”H. Odd heights include 6” gap and even heights include 7” gap. See the Sport and TRU-Comfort back availability chart for stock order back size ranges.

TRU-BALANCE® 3 SEATING continued

Set Interface Width at:______ (Range 16”-24” Wide)

Set Overall Height at:______

TRU-Balance® 3 Back ShroudREQUIRED. The back shroud is a feature of the TRU-Balance 3 seating system and is available in matching shroud colors. The back shroud is not available with the back cane configuration. Reference colors shown on page 2.

Additional TRU-Balance® 3 Back OptionsOptional.

TRU-Comfort Lateral Wings, pair ..................... No Charge

Adds lateral wing to Sport Backs. Standard with TRU-Comfort Backs. Not available on power tilt backs 16”-17”H with limited adjustability on 18” H. Not available on power recline back 19”-20”H with limited adjustability on 21”H.

Privacy Flap, 9.75” ............................................... $40Standard on recline seating systems. Not covered by AADl

Privacy Flap, 12.75” ............................................. $40Standard on recline seating systems. Not covered by AADl

ARMRESTSREQUIRED. Select the desired type of armrest below. Please read notes to ensure seating compatibility. Be sure to also select an armrest size and armpad type.

TRU-Balance® 3 Flip-Back ArmrestsChoose a left and right TRU-Balance 3 armrest and set height and optional downpost if desired. Different Left (L) and Right (R) armrest height packages are allowed. Not available with Back Cane Option.

Set RIGHT height at:______Set LEFT height at:______

TRU-Balance 3 Armrest Downpost (Pair) .......................................................................................................... $95**No Charge with Recline Systems. Available up to 2” difference between seat and back width via endomorph or mesomorph configuration. Not available on 14” Width seat or back.

Back Cushion WidthAvailable with +/-4” of seat width.

Set Width at:______

Aftermarket Back Interface Preset Width

Back in Black

Midnight Blue

Back in Black ................................................Standard

Non-matching Back Shroud .................................... $105Select color below Not covered by AADl

Match Back Shroud to Base Color ............................ $105Not covered by AADl


No Armpad Selection and/or See Positioning Components Page or Order Form .................................................. No Charge

Straight, Armpad .......................................Standard Waterfall, Armpad .................................... No Charge

Foam ArmpadsSelect a left and right standard type armpad (mix or match) OR choose the gel armpads that follow.

Falcon Gel Left and Right Armpad:Full Length .................................................... $150 eaDesk Length .................................................. $100 eaFor use with TB3 standard armrests.

Falcon Gel Left and Right Armpad with Mounting Plate:Full Length. ................................................... $210 eaDesk Length .................................................. $160 eaFor use with 2-Post, Heavy Duty Removable, or Pediatric Armrests.

ARMPADSREQUIRED. Select to omit an armpad selection or select a left and right armpad length and a type of left and right armpad. Please note that waterfall and gel armpads may cause interference with the seat back.

JOYSTICK BRACKET RECEIVERREQUIRED.

HEADRESTSOptional. Select a headrest pad and bracket. Standard Stealth pricing applies.

Standard Fixed Receiver ..................................Standard

Stealth Height Adjustable Receiver .......................... $165Tube Arm Part: ST-ARM250C-Q Track Arm Part: ST-ARM250T-Q

Headrest Pads

Headrest Bracket

14” Full Length 10” Desk Length

ARMREST SIZEREQUIRED. Select a Left (L) and Right (R) armrest size. This also affects the armpad selection below.

Heavy Duty, Removable ArmrestsSelect a type of HD removable armrests and the set height. Only one height package is selectable as a normal configuration.

8”-12”H, Single Post, Height Adjustable, ............. $130 ea.Removable, Heavy Duty (Sold as pair)

10”-14”H, Single Post, Height Adjustable, ............ $130 ea.Removable, Heavy Duty (Sold as pair)

Set LEFT height at:______

ARMRESTS continued

Set RIGHT height at:______

Two-Post ArmrestsSelect the armrest and set the left and right heights. These armrests may interfere with offset backs/ back canes.

Set RIGHT height at:______Set LEFT height at:______

2-Post, Flip Back, Height Adjustable, and Removable Armrests (9”-13” Height) .......................................................$145**No charge with Power Positioning. Not available with a depth less than 16”. Required with flip forward back and laptrays.

Falcon Gel ArmpadsSold only in pairs. Select an armpad set below. Armpads are 3” wide. The mounting plate allows the armpad to be offset from the armrest tube.

Stealth 8” Comfort Plus (CP450) ...............$190Part: POS148484

Stealth 10” Comfort Plus (CP250)(A) ..........$190Part: SETHEAD1057

Stealth 14” Comfort Plus (CP150) ..............$190Part: INDPART2327

Pediatric Comfort Plus (6”Wx4.5”H) ..........$190(CPN350)Part: SETHEAD1069

Stealth Small Contoured (9.75”Wx3”H) ........$80(STL-OTSM250)Part: SETHEAD1052

Stealth Large Contoured (11”Wx6”H) (B) .....$100(STL-OTLG150)Part: SETHEAD1053

Stealth’s Worlds Best Removable .............. $255Headrest Bracket (TWB485-1) (C)Part: FRMASMB15999

Stealth Multi-Axis Removable Headrest ..... $200Bracket (HMO475P) (D)Part: HDWASMB1084


POWER POSITIONING ELECTRONICSREQUIRED, except with Static Seat without power options. Select the desired control type for the seating system. Please note the available actuator controls. The 4-way toggle and 4 function push button are mounted on the same side as the joystick.

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.

Independent Legrests (Requires 2 actuator controls)

Combined Legrests (Requires 1 actuator control)

Articulating Foot Platform (Requires One Actuator Contol)

Attendant Control ..............................................$630*Part: ELE125264

Seat Mounted, LED Light Package ............................ $770

Attendant ControlOptional. *Attendant control will be no charge when ordered with Power Tilt and Recline System.

Seat Mounted, LED Light PackageOptional. Available only with NE+ 8 Key Joystick or Q-Logic 3 Ex Joystick for LED Lights. Standard battery and accessory pricing applies. Not covered by AADL.

MANUFACTURER INSTALLED ACCESSORIESOptional. Standard battery and accessory pricing applies. Not covered by AADl

Push Handles (pair) ...............................$140Not available with oxygen holder, back cane option, or vent tray. Required with attendant manual recline.

Accessory Bar ....................................... $90Standard with the SCIM module, Trilogy vent tray, and oxygen holder. May be added to mount additional acces-sory to back of unit. Not available with back cane option.

Trilogy Vent Tray ................................. $420Part: ACC136791

Compact Vent Tray ............................. $1,495Part: ACC133889

LAP BELTSREQUIRED. Select a lap belt below. Standard Stealth pricing applies.

38” Lap Belt 50” Lap Belt 60” Lap Belt 70” Lap Belt 80” Lap Belt 90” Lap Belt

Standard Lap Belts

Through NE+ ................................ No Charge

Through Q-Logic Joystick ................ No Charge

Through Toggle Control (Tilt Only) ................... No Charge

Switch Controls

iAccessFlat Button

iAccessToggle Button

Through Q-Logic 3 Controller and ............ $625Interface

Through Flat Button iAccess and ............ $1,525Q-Logic 3 Controller and Interface

Programmable up to 15 functions. Only available with TRU-Balance 3 armrests.

Through Toggle Button iAccess and ........ $1,525Q-Logic 3 Controller and Interface

Programmable up to 15 functions. Only available with TRU-Balance 3 armrests.

Single/Multiple Power Electronics (includes AAM)

Single Power Electronics (includes AM1)

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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

Power Reclineor Static Seat

Low Med. High Low Med. High Low Med. High

Power Tilt Power Lift

Angle Adjustable, 11”-13”

Angle Adjustable, 14.5”-18”

Small Calf Pad (pair) 6”Wx6”H ..................$210

Large Calf Pad (pair) 8” taper to 6”Wx8”H ..$210

Small Calf Panel 18”Wx8”H .....................$210

Large Calf Panel 24”Wx8”H .................... $265Only available on widths of 20” or greater.

Width Extension, 8”D and 11”D Footplates .................$55

2” Bell-Shaped Length Extension ..............................$55Not compatible with width extensions. Can be used with 6” outside edge with 11” footplates.

4” Outside Edge ...................................................$55Only available with 6”D footplates and 8”D footplate extension.

6” Outside Edge ....................................................$55Available with 8”D and 11”D footplates and 11”D footplate extension.

Reversed Dartex Calf Pad or Panel Cover (pair) .......... $150

Wheel Bumpers (pair) ............................................$30

Footplate Connector ..............................................$55

Center Mount Calf SupportOptional. 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.

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

Additional Accessories

70° Articulating, Swing-Away Legrest ...........$2,865 ea.

11”-13” Length 114.5”-18” Length

Lower Extension

Power Articulating, Swing Away Legrest

Left and Right Legrests will Match Left and Right Legrests will not match One Legrest (Left or Right as Marked)

Configuration Verification

Set Length at:______

5”x6” Footplates 5”x8” Footplates 5”x11” Footplates

Center Mount Footplates

8”-12” ExtensionN/A with Power Articulation.

10”-16” Extension 13”-19” Extension

Power Articulating Foot Platform ..........................$3,145Not covered by AADL

Manually Adjustable Center Mount .......................... $580Foot Platform, 12"W-20"W Static Seat

Manually Adjustable Center Mount .......................... $265Foot Platform, 12"W-20"W Power Positioning Seating

Manually Adjustable Center Mount .......................... $790Foot Platform, 20"W-24"W Static Seat

Manually Adjustable Center Mount .......................... $475Foot Platform, 20"W-24"W Power Positioning Seating

Center Mount Lower Extension

LEGRESTSOptional. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guide-lines. Some adjustments may be needed upon receipt of the unit. Reference the section’s compatibility matrix for legrest interference.

Center Mount Foot PlatformsIf power articulating foot platform is selected, be sure power legrest control has been selected in previous section.



Center Mount Foot Platform Compatibility Matrixfor TRU-Balance® 3




10”-16” Length Extension

13”-19” Length Extension

70° Power Articulating, Swing Away Legrests 4” of articulating range. Be sure power legrest control has been selected in previous section. Select an upper, lower extension, and footplate. Left (L) and right (R) configurations are selected by checking the appropriate boxes. Not covered by AADL.



60°-90° Swing-Away Legrest Compatibility Matrix




Extruded, 11”-16.5”

11”-13” extension causes no interference at all seat-to-floor heights.

Extruded, 13”-16.5”

Angle Adjustable, 15.5”-19.5”Multi-Axis, 11”-16.5”

Multi-Axis, 15.5”-19.5”

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

60°-90° Swing-Away Legrest ............................. $265**No charge with Power Positioning. Lower extensions with mini-mum 11” length utilize a short style legrest upper.

11”-13” LengthN/A with Multi-axis

11”-16.5” LengthN/A with Angle Adjustable

13”-16.5” LengthN/A with Multi-Axis

15.5”-19.5” Length

60°-90° Swing-Away LegrestsAdjustable in 5° increments. Select a configuration, a legrest upper, a legrest extension, and type of footplate. Left (L) and right (R) configura-tions are selected by checking the appropriate boxes.

Lower Extension

Swing-Away Legrest Upper

Extruded Footplate(s)7.25”Wx6”D Extruded Footplate ....................Standard

8.5”Wx6”D Extruded Footplate .....................StandardMay cause interference on seat widths less than 18.”

Angle Adjustable with Heel Loops ................$87.50 ea.(Select footplate size)

Multi-Axis (Select footplate size) ................... $260 ea.

Left and Right Legrests will match Left and Right Legrests will not match One Legrest (Left or Right as Marked)


LEGRESTS continued

4”Wx6”D 5”Wx6”D 5”Wx8”D 6”Wx8”D1 6”Wx11”D1 8”Wx11”D2

Angle Adjustable or Multi-Axis Footplate Size¹The 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”.

Heel Loops (pair) ..................................................$35Part: FRMASMB7873 Standard on angle adjustable and multi-axis footplates.


Gel Neoprene Footrest Sleeve (pair) ........................ $130Part: INDPART2243

60°-90° Swing-Away Legrest Accessories


Calf Pad (pair) 6”Wx6”H ................................ No Charge Gel Padded Knee Abductor Buttons (pair) ................. $125INDPART2242

Accessories


Angle Adjustable Footplate)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”.

Angle Adjustable or Multi Axis Selection

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Elevating Legrest Compatibility Matrix




Reinforced, 11”-14”

Angle Adjustable, 14.5”-18”

Reinforced, 14”-17”Angle Adjustable, 12”-14.5”

AccessoriesHeel Loops (pair) ..................................................$35Part: FRMASMB7873 Standard on angle adjustable footplates.


Falcon LPW Gel Padded Adductor Buttons (pair) ......... $125Part: INDPART2242

Elevating Legrest Assembly ............................... $550Select lower extension and footplates

Elevating Legrest

LEGRESTS continued

Left and Right Legrests will match Left and Right Legrests will not match One Legrest (Left or Right as Marked)


11”-14” LengthFor reinforced only

12”-14.5” LengthFor angle adjustable only

14”-17” LengthFor reinforced only

14.5”-18” LengthFor angle adjustable only

Lower Extension

Reinforced Cast Footplate(s)7.25”Wx6”D Reinforced Footplate ..................Standard

8.5”Wx6”D Reinforced Footplate ...................StandardMay cause interference on seat widths less than 18.”

Angle Adjustable with Heel Loops ................$87.50 ea.(Select footplate size below)


Angle Adjustable Size¹The 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”.


Elevating LegrestsSelect a configuration, a legrest upper, a legrest extension, and type of footplate. Left (L) and right (R) configurations are selected by checking the appropriate boxes.

Angle Adjustable Footplate(s)

PROVIDER INSTALLED ACCESSORIESOptional. Multiple accessories can be mounted along the various tracks but some interference may occur. Standard accessory pricing appliesNot covered by AADL.

TRU-Balance Cup Holder .......................... $20For use with TRU-Balance 3 (track style) armrests.

Cup Holder (Tube-style Armrest) ............... $20For use with tube-style armrests.

TRU-Balance Backpack Holder (Pair) (A) ...... $42Not available with back cane option.

TRU-Balance Glove Box (C) ....................... $85

TRU-Balance Transfer Bar, ..................... $305Quick Release (Pair) (D)

TRU-Balance Front Mounted ..................... $95Cell Phone Holder (E)

Large, Black, Weather Cover ................... $240

TRU-Balance Reflector Kit ........................ $35

TRU-Balance Personal Item Hook ............... $20Not available with back cane option.

TRU-Balance Rear View Mirror .................. $35

TRU-Balance Oxygen Holder ....................$110

TRU-Balance Tablet Holder ..................... $565

TRU-Balance Clothing Guard (Pair) ........... $275

Quantum Backpack ................................. $75


BATTERIESREQUIRED. Select a type of battery below, or to omit the batteries. The powerchair requires 2 batteries. Standard battery and accessory pricing applies.

Install Batteries ........................................... No Charge Do Not Install Batteries .................................. No Charge

Battery InstallationPlease choose if batteries will be installed, if selected above.

Group 24, 70 Amp Battery ............................... $460 ea.

No batteries. Provider will assume responsibility of batteries.

SPECIALTY CONTROLSOptional. Select a type of specialty controls below or to refer to the specialty controls order form. Standard Stealth pricing applies.

Enhanced Display and EX SAJ Joystick

Black, Soft Touch ............................ Standard

Non-matching Joystick Shroud .................. $75Select color below. Not covered by AADL

Match Joystick Shroud to Base Color ........... $75Part: See color below. Not covered by AADL

Q-Logic 3 Enhanced Display ShroudRequired with Q-Logic 3 Enhanced Display selection above. Reference colors shown on page 2.

Q-Logic 3 Enhanced Display Kit .............$2,045Select 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.

Q-Logic 3 EX SAJ ................................. $850Must be used in conjunction with Enhanced Display or Q-Logic 3 Joystick.

Q-Logic 3 SCIM .................................... $850Allows use of joystick display for specialty devices.

Back in BlackPart: DGN137729-PBK1

Midnight BluePart: DGN137729-PBU10

q6 edge z order form with tru-balance 3 positioning aadl ... · q6 edge® z order form with...

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