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of 2INFINFB4044/RevB/01MAY2019

4. Substitute Cushion CoverThe Solution SPP cushion is standard with a Coolcore cover (SOLSPP-NBLKXXYY). The standard can be substituted with a Tek 2 or Mesh Cover with the selection below.

Substitute with Tek 2 CoverPart: SOLSPP-TBLKXXYY

Substitute with Mesh CoverPart: SOLSPP-MBLKXXYY

1. Cushion Selection

3. Add Solid Base

5. Notes

401 York Ave., Duryea, PA 18642 | Phone: 866-800-2002 | Fax: 866-707-3422 | Email: [email protected] Solution SPP Cushion Order Form

Cushion Depth: ______

Cushion Width: ______

Cushion Part: ST-SOLSPPXXYY

Solution SPP Cushion, 10"-20" Wide, E2607 ......................... $375Solution SPP Cushion, 22"-24" Wide, E2608......................... $430

This form is interactive when viewed with Adobe Acrobat Reader and may not func-tion correctly if opened with applications other than Acrobat. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for determining appropriate billing codes when submitting for insurance reimbursement. All prices are on-chair MSRP. Prices, specifications, part numbers, and availability are subject to change without notice.

Account Number: ___________ Date: ________________

Provider Name: __________________________________

Contact: ________________________________________

Phone: ___________________ Fax: _________________

Email: __________________________________________

PO Number: _____________________________________

Marked for: _____________________________________

Ship to Address: _________________________________

City: _____________________ State: ______ Zip: ______

_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

2. Substitute Fluid Proof LinerThe Solution SPP cushion is standard with an urethane liner but can be substi-tuted with selection below. See parts list attachment for specific prices.

Fluid Proof Polyurethane Liner .................................... $55-$75Part: PUL1709030-XXYY

ABS Flat Rigidizer ..................................................... $45-$65Part: See parts list attachment.

ACM Rigidizer ................................................................$95Part: See parts list attachment.For use with manual wheelchair only.

14”12”10” 16” 17” 18” 19” 20” 22” 24”Width

Dept

h

Solution SPP CushionThis cushion offers skin protection and positioning with a Coolcore, 4-way stretch, breathable cover and an urethane liner. Weight capacities are 175 lbs for 10"-14" width, 350 lbs for 15"-21" width, and 500 lbs for 22" width and greater. The XXYY portion of all part numbers on this page directly relate to the dimensions of the cushion, where XX represents the width and YY represents the depth. For example, a 16" wide and 18" deep cushion would be ST-SOLSPP1618. Available sizes are shown on the chart to the right. Part numbers and prices for options with less predictible part numbers or prices can be found on the parts list attachment. Multiple cushion orders can be configured on the second page.

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_____________________________________________________________________________________ _____________________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Account Number: ___________ Date: ________________ Marked for: _____________________________________

©2019 Quantum Rehab.All rights reserved.

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twitter.com/quantumrehab

Special Order Solution SPP CushionPlease detail your special order cushion request. All special order cushion requests must be approved with the Quantum Custom Department. Please contact Quantum Inside Sales or Custom Department with questions. Extended lead time will apply. Cushion part numbers involved will be the cushion part number listed in previous sections modified to meet special order request stated in details below. Drawings are available below for sketch details.

Special Order Solution SPP Cushion. E2607/E2608......................................................................................................... $525-$585

Rear View

Right Side View

Top View

Details

Multiple Order Solution SPP CushionThis section allows multiple cushions of various sizes to be ordered. Reference parts, prices, and available sizes on the previous page.

Quant

ity

Width

Depth

Ureth

ane

Polyu

r.ABS AC

M

Coolc

ore

Tek 2

Mesh

A

B

C

D

E

F

Liner

Rigid

izer

Cove

rSiz

e

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of 1Stealth Solution Cushion Parts List: Liners and Rigidizers/15JAN2019

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Stealth Solution Cushion Parts List: Liners and Rigidizers

10"W x 10"D .... URL1709070-1010 .... $5010"W x 12"D .... URL1709070-1012 .... $5012"W x 10"D .... URL1709070-1210 .... $5012"W x 12"D .... URL1709070-1212 .... $5014"W x 12"D .... URL1709070-1412 .... $5014"W x 14"D .... URL1709070-1414 .... $5014"W x 16"D .... URL1709070-1416 .... $5014"W x 18"D .... URL1709070-1418 .... $5016"W x 16"D .... URL1709070-1616 .... $5016"W x 17"D .... URL1709070-1617 .... $5016"W x 18"D .... URL1709070-1618 .... $5016"W x 19"D .... URL1709070-1619 .... $50

16"W x 20"D .... URL1709070-1620 .... $5017"W x 16"D .... URL1709070-1716 .... $5017"W x 17"D .... URL1709070-1717 .... $5017"W x 18"D .... URL1709070-1718 .... $5017"W x 19"D .... URL1709070-1719 .... $5017"W x 20"D .... URL1709070-1720 .... $5018"W x 16"D .... URL1709070-1816 .... $5018"W x 18"D .... URL1709070-1818 .... $5018"W x 19"D .... URL1709070-1819 .... $5018"W x 20"D .... URL1709070-1820 .... $5018"W x 22"D .... URL1709070-1822 .... $5019"W x 18"D .... URL1709070-1918 .... $50

19"W x 19"D .... URL1709070-1919 .... $5019"W x 20"D .... URL1709070-1920 .... $5020"W x 16"D .... URL1709070-2016 .... $5020"W x 18"D .... URL1709070-2018 .... $5020"W x 19"D .... URL1709070-2019 .... $5020"W x 20"D ....URL1709070-2020 .... $5020"W x 22"D ....URL1709070-2022 .... $6022"W x 18"D .... URL1709070-2218 .... $6022"W x 20"D ....URL1709070-2220 .... $6022"W x 22"D ....URL1709070-2222 .... $6024"W x 20"D .... URL1709070-2420 .... $6024"W x 22"D .... URL1709070-2422 .... $60

10"W x 10"D .... PUL1709030-1010 .... $5510"W x 12"D .... PUL1709030-1012 .... $5512"W x 10"D .... PUL1709030-1210 .... $5512"W x 12"D .... PUL1709030-1212 .... $5514"W x 12"D .... PUL1709030-1412 .... $5514"W x 14"D .... PUL1709030-1414 .... $5514"W x 16"D .... PUL1709030-1416 .... $5514"W x 18"D .... PUL1709030-1418 .... $5516"W x 16"D .... PUL1709030-1616 .... $5516"W x 17"D .... PUL1709030-1617 .... $5516"W x 18"D .... PUL1709030-1618 .... $5516"W x 19"D .... PUL1709030-1619 .... $55



Cushion Size Part MSRP Cushion Size Part MSRP Cushion Size Part MSRP

Cushion Size Part MSRP Cushion Size Part MSRP Cushion Size Part MSRP

Account Number: ___________ Date: ________________ Marked for: _____________________________________

Cushion Size Part MSRP Cushion Size Part MSRP Cushion Size Part MSRP10"W x 10"D ......DWR1010E188A ..... $4510"W x 12"D ......DWR1010E188C ..... $45

12"W x 10"D ......DWR1010E189A...... $4512"W x 12"D ......DWR1010E189C ..... $4512"W x 14"D ......DWR1010E189E ...... $4514"W x 12"D ......DWR1010E190C ..... $4514"W x 14"D ......DWR1010E190E...... $4514"W x 16"D ......DWR1010E190G ..... $4514"W x 18"D ...... DWR1010E190I ...... $4516"W x 16"D ......DWR1010E191G...... $45

16"W x 18"D ...... DWR1010E191I ...... $4516"W x 20"D ......DWR1010E191K ...... $45

17"W x 17"D ..... DWR1010E234H ..... $4517"W x 19"D ......DWR1010E234J ..... $4518"W x 16"D ......DWR1010E192G ..... $4518"W x 18"D ...... DWR1010E192I ...... $4518"W x 20"D ......DWR1010E192K ..... $4518"W x 22"D ..... DWR1010E192M ..... $4519"W x 17"D ..... DWR1010E234H ..... $4519"W x 19"D .... MEC1804152-1919 .... $45

20"W x 16"D ......DWR1010E193G ..... $5520"W x 18"D ...... DWR1010E193I ...... $55

20"W x 20"D ......DWR1010E193K...... $5520"W x 22"D ......DWR1010E193M ..... $5522"W x 18"D ...... DWR1010E194I ...... $5522"W x 20"D ......DWR1010E194K ..... $5522"W x 22"D ..... DWR1010E194M ..... $5524"W x 20"D ......DWR1010E236K ..... $5524"W x 22"D ..... DWR1010E236M ..... $55

ABS FLAT RIGIDIZER

16"W x 16"D .........CUS142467 ........ $9516"W x 17"D .........CUS142467 ........ $9516"W x 18"D .........CUS142467 ........ $9518"W x 16"D ........ CUS142466 ........ $95

18"W x 18"D ........ CUS142466 ........ $9518"W x 19"D ........ CUS142466 ........ $9518"W x 20"D ........ CUS142466 ........ $9520"W x 18"D .........CUS142465 ........ $95

20"W x 19"D .........CUS142465 ........ $9520"W x 20"D .........CUS142465 ........ $95

Cushion Size Part MSRP Cushion Size Part MSRP Cushion Size Part MSRPACM RIGIDIZER

This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for determining appropriate billing codes when submitting for insurance reimbursement. All prices are on-chair MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. ©2019 Quantum Rehab - A Pride Mobility Products Corporation company. All rights reserved..

POLYURETHANE CUSHION LINERS

URETHANE CUSHION LINERS

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