Page 1 of 16 INFINFB3914/RevB/01MAY2018 Rival ® Order Form with Contoured, Synergy, and TRU-Balance Flex Seating Quantum ® Rehab 401 York Ave., Duryea, PA 18642 Phone: 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 MODEL REQUIRED. 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 ...................................................$6,608 Part: QRIVAL 3S-SS. HCPCS: K0848 Solid seat pan standard with no power option. Quantum Rival 3S-C ....................................................$6,608 Part: QRIVAL 3S-C. HCPCS: K0849 Contoured Seat (Captain) Standard.
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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]
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.
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.
Red CorvettePart: DGN164245-PRD1
Electric BluePart: DGN164245-PBU9
Back in BlackPart: DGN164245-PBK1
White SatinPart: DGN164245-PWH2
Pretty in PinkPart: DGN164245-PPK3
Deep PurplePart: DGN164245-PPR5
Lime LightPart: DGN164245-PGN7
Grey StreetPart: DGN164245-PSL3
Silver BulletPart: DGN164245-PSL7
Midnight BluePart: DGN164245-PBU10
Orange CrushPart: DGN164245-POR6
Yellow BlazePart: DGN164245-PYL3
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.
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.
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
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.
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.
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.
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
16”Wx18”D ....................... No ChargePart: SETASMB3179
16”Wx20”D ....................... No ChargePart: SETASMB3180
18”Wx16”D ....................... No ChargePart: SETASMB3181
18”Wx18”D ....................... No ChargePart: SETASMB2848
18”Wx20”D....................... No ChargePart: SETASMB3182
20”Wx16”D ....................... No ChargePart: SETASMB3183
20”Wx18”D ....................... No ChargePart: SETASMB3184
20”Wx20”D ...................... No ChargePart: SETASMB3185
16”Wx16”D ....................... No ChargePart: SETASMB2770
16”Wx18”D ....................... No ChargePart: SETASMB2771
16”Wx20”D ....................... No ChargePart: SETASMB2772
16”Wx22”D ....................... No ChargePart: SETASMB4887
18”Wx16”D ....................... No ChargePart: SETASMB2775
20”Wx16”D ....................... No ChargePart: SETASMB2780
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
20”Wx18”-20”D with 60" Lap Belt ............................. No ChargePart: SETASMB6896
22”Wx20”-22”D with 70" Lap Belt ............................. No ChargePart: SETASMB6897
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
16”Wx18”D .......... No ChargePart: SETASMB2560
18”Wx16”D .......... No ChargePart: SETASMB2159
18”Wx18”D .......... No ChargePart: SETASMB2551
Contoured seating section continued on following page.
16”Wx16”D .......... No ChargePart: SETASMB3112
16”Wx18”D .......... No ChargePart: SETASMB3113
18”Wx16”D .......... No ChargePart: SETASMB2492
18”Wx18”D .......... No ChargePart: SETASMB3114
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”-18” Width PackagePart: FRMASMB18012
16”-20” Width PackagePart: FRMASMB18013
20”-24” Width PackagePart: FRMASMB18014
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”-18” Depth PackagePart: FRMASMB17823
15”-20” Depth PackagePart: FRMASMB7732
20”-24” Depth PackagePart: FRMASMB7733
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.
4” Mesomorph (2” per side) Back Cane ...............................$195Part: FRMASMB12091Select a cane height.
2” Endomorph (1” per side) Back Cane ...............................$195Part: FRMASMB12115Select a cane height.
4” Endomorph (2” per side) Back Cane ...............................$195Part: FRMASMB12139Select 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.
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
17” High Canes18” High Canes19” High Canes
20” High Canes21” High Canes22” High Canes
23” High Canes24” High Canes25” High Canes
12” High Back13” High Back14” High Back
15” High Back16” High Back17” High Back
18” High Back19” High Back20” High Back
21” High Back22” High Back23” 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
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.
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.
15.2. TRU-Balance Flex Seat Dimension - WidthREQUIRED with TRU-Balance Flex seating. Maximum seat width is 22". Part number is SETWDTH plus number following # below.
15.3. 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.
2” Mesomorph (1” per side) Back Cane ...............................$195Part: FRMASMB12067Select a cane height.
4” Mesomorph (2” per side) Back Cane ...............................$195Part: FRMASMB12091Select a cane height.
2” Endomorph (1” per side) Back Cane ...............................$195Part: FRMASMB12115Select a cane height.
4” Endomorph (2” per side) Back Cane ...............................$195Part: FRMASMB12139Select 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
Ove
rall
Hei
ght
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".
14” High Canes15” High Canes16” High Canes
17” High Canes18” High Canes19” High Canes
20” High Canes21” High Canes22” High Canes
23” High Canes24” High Canes25” High Canes
12” High Back13” High Back14” High Back
15” High Back16” High Back17” High Back
18” High Back19” High Back20” High Back
21” High Back22” High Back23” High Back
24” High Back25” High Back
TRU-Balance Flex seating section continued on following page.
Page 8 of 16INFINFB3914/RevB/01MAY2018
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
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
50” Lap BeltPart: ACCBELT1000
60” Lap BeltPart: ACCBELT1002
70” Lap BeltPart: ACCBELT1003
80” Lap BeltPart: ACCBELT1004
90” Lap BeltPart: ACCBELT1001
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
Page 9 of 16INFINFB3914/RevB/01MAY2018
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
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.
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.
Page 10 of 16INFINFB3914/RevB/01MAY2018
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.
5”Wx6”DPair part: FRMASMB7449. Left part: RIG133544. Right part: RIG133567.
5”Wx8”DPair part: FRMASMB7450. Left part: RIG133545. Right part: RIG133568.
6”Wx8”D1Pair part: FRMASMB7451. Left part: RIG133547. Right part: RIG133569.
6”Wx11”D1Pair part: FRMASMB7452. Left part: RIG133548. Right part: RIG133570.
8”Wx11”D2Pair part: FRMASMB7453. Left part: RIG133549. Right part: RIG133571.
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
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.
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.
8.5”Wx6”D Extruded Footplate ......................... StandardPart pair: FRMASMB7848. Left: FRMASMB7863 Right: FRMASMB7864May cause interference on seat widths less than 18.”
Page 11 of 16INFINFB3914/RevB/01MAY2018
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”.
20.5. 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.
8.5”Wx6”D Reinforced Footplate ....................... StandardPair part: FRMASMB4747. Left: RIG138060. Right: RIG138062May cause interference on seat widths less than 18.”
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
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.
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
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.
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)
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.
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
2 to 1 Switch Adapter .................................................................................................................................................. $13.39Part: DWR1361H037 Connects 2 single switches to a stereo jack to act as a dual switch.
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
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)
SETASMB6447 SEAT BACK,ASSY,SYNERGY STANDARD BACK,14"W,13"H,W/CUSHION,(14"W X 10"H BACK)
SETASMB6623 SEAT BACK,ASSY,SYNERGY STANDARD BACK,14"W,14"H,W/CUSHION,(14"W X 10"H BACK)
SETASMB6449 SEAT BACK,ASSY,SYNERGY STANDARD BACK,14"W,15"H,W/CUSHION,(14"W X 12"H BACK)
SETASMB6625 SEAT BACK,ASSY,SYNERGY STANDARD BACK,14"W,16"H,W/CUSHION,(14"W X 12"H BACK)
SETASMB6461 SEAT BACK,ASSY,SYNERGY STANDARD BACK,14"W,17"H,W/CUSHION,(14"W X 14"H BACK)
SETASMB6637 SEAT BACK,ASSY,SYNERGY STANDARD BACK,14"W,18"H,W/CUSHION,(14"W X 14"H BACK)
SETASMB6472 SEAT BACK,ASSY,SYNERGY STANDARD BACK,14"W,19"H,W/CUSHION,(14"W X 16"H BACK)
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
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Section NameOption Name MSRP Part Number Manufacturer Extended Description
$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
Standard FRMASMB17102 BACK CANE,ASSY,W/SHORT PUSH HANDLE,19"H,SLING,SYNERGY,TEXTURED$62.50 x 2qty FRMASMB15777 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,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
Standard FRMASMB17106 BACK CANE,ASSY,W/SHORT PUSH HANDLE,23"H,SLING,SYNERGY,TEXTURED$62.50 x 2qty FRMASMB15781 BACK CANE,ASSY,W/NO PUSH HANDLE,STRAIGHT,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