Quickie IRIS March 2016

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ST: ZIP: ( ) Fax: ( ) ST: ZIP:

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( ) Fax: ( ) a a o o o

o Left o Right(Facing from rear) o o o o o o o o o

To order any JAY cushions on-chair, please see the JAY price list.

Cushion name or part number must be filled out with desired width and depth.

Quickie IRIS

Custom Seating Depth: Width: o 183TT12

JAY Bundled Cushion

183ST54 Omit Seat Pan

JAY Cushions (Optional)

Contracture Seat Frame NA w/ 14" or 15" frame depths. NA w/ drop seat pan.

NC 183FT46

NC o

Drop Seat Pan NA w/ transit, HD, contracture footrest system Standard Seat Pan

For growth ranges, see Figure 1.5

183ST35 $200.00

$200.00 E2231

183ST36

183JC20 Cushion Name/Part #: Price List

$500.00

Width Adjusting System Avail. range 14"-21". Max growth 22" NA with Mono Back

183FS23

183WM56 $2,945.00

E2201 22"_{handle extension}NA w/ removable stroller

Base Model o o 183TT8 o NC

Backrest Dual trigger cable releases NC

NC E1161

183TA6

183W10

+5 to 60°

NA w/Heavy Duty Package

o NC Foot Release - No Cables

NA with Vent and Battery Tray. NA with 21-22" depth and +5° set-ups.

Tilt Release Options

E1161

183W11 E2201 20" 14"

Pre-Set Tilt Angle (40° range) (Default in Bold)

NC 17" NC 183W9 NC $45.00 NC Fixed (Standard) HCPCS

Quickie IRIS with True Fit Growth For 14" sizes use E1233

183GY02 o Dealer Phone: Confirm Via: Price Dealer Address: Confirmation Email: E1161 0 to 55° PO#: Ship To City:

Mark For:

Dealer Acct #: HCPCS Date: Dealer: Price Option #

183TA5 E1161 -5 to 50°_{NA w/ Heavy Duty and 12.5" STFH} NC

ADDITIONAL SHIPPING INFORMATION

Definition Dealer Contact:

Option #

+5 to 45°

NA w/Heavy Duty Package

21" NA w/ removable stroller handle extension NC 183TA1 E1161 183W5 15" Dealer City: Definition 183GY01 1. FRAME Frame Width o E1161 STD o 183TA7 Frame Options $395.00 Standard Base and Seat Frame

Maximum Weight: 250 lbs. o

o NC

o 183TA8 E1161 -5 to 35°_{NA w/ Heavy Duty and 12.5" STFH}

Pre-Set Tilt Angle (55° range) (Default in Bold)

Quote

Order

Attention: NC 183W12 STD o NC 183W13 o NC 18" $500.00 $500.00 0 to 40° 19" 16" 2. SIZE / SEATING 183W6 o 183TA10 183W8 183W7 E2201

The HCPCS CODES provided are based on code verification through PDAC or our interpretation of the code definitions.

The use of HCPCS CODES does not ensure coverage or payment. For coverage information, verify the appropriate payer's coverage policy. Address:

EIZ4-2

Fax Email Ship To Phone:

Submitting for:

Transit o 183TO45 Address: Seat Type 183HV1 183FS24 Ship To: E1029

Vent/Battery Tray BaseNA w/ Attendant Wheel Lock, Mono Back and

14" and 15" frame width; min 17" STFH.

$425.00

WC-19 Transit Option $250.00

Heavy Duty Package (Max: 350lbs) NA w/ Vent, Battery Tray and Mono Back

Frame Struts

March 2016

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a Option # HCPCS Definition Price a Option # HCPCS Definition Price

See Figure 1.2, Dimension B. Distance from seat surface to top of the head. o

o o

251-350 lb options only available w/ HD Package o

o o

o o See Figure 1.1 for pricing, Figure 1.2, Dimension A for measurement o

o o o o o o o o o o o o o o o o o o 4" x 1.25" Semi Pneumatic

NA w/ Heavy Duty Option NC

183CW53

183SD33 E2204

A. Top of Cushion to Seat Rail

Below Seat Rail NC

3. CASTERS 20" 22" Figure 1.1 Casters o 251 - 300 lbs NC NC 183CW73 183FD17

20" recommend long seat frame

NC See FIGURE 1.3 Dimensions A & B. This measurement is taken from the top of the cushion to the upper surface of the seat rail. If the cushion has a wedged shape and/or has significant lateral pelvic contour, then determine the height of the cushion at the point where the ischial tuberosities would contact (not immerse) the cushion surface.

183CJ03

183FL91

183FD9

E2203 21" recommend long seat frame E2203

18" recommend medium seat frame 16" recommend short seat frame

183FD16 $550.00

183FD11

NC

183SD8 15" NC 22" recommend long seat frame

183SD7

Medium Seat Frame 16"-20"

183SD11 183BO02 Figure 1.1 B. Frame Depth NC 14" NC NC

19" recommend medium seat frame 17" recommend short seat frame 183FD6

183FD7

NC 183FD5

Long Seat Frame 18"-22" NC

A. User's Weight (Default in Bold)

2. SIZE / SEATING (CONT) Fill out either A or B)

O

R

A. Setup By QUICKIE

NC

14" recommend short seat frame NC

$900.00 E2204 183FD10 $550.00 16" NC 0 - 250 lbs 37" or Greater NC 19" Figure 1.1 183FL92 Less than 37" NC

A. Desired Seat Depth

21" Figure 1.1 17" 183BO03 18" Figure 1.1 E2203 NC E2203 301 - 350 lbs 2 1/2" or Greater NC Less than 2 1/2" 183CJ02 183FL93 183SD14 183SD13 183SD9 183SD10 Figure 1.1 183SD12 183SJ01 183SJ02 183BO01 NC 183FD8

15" recommend short seat frame

183CJ01

A. User's Seated Height B. Frame Depth Range

B. Setup By DEPTH

Short Seat Frame 14"-18" NC

8" x 1" Polyurethane NC 183CW39 8"x 1.5" Semi Pneumatic $85.00 5" x 1" Polyurethane NC _o 183CW36 E2214_E2215 183CW46 8"x 2" Pneumatic $145.00 183CW7 5" x 1.5" Semi Pneumatic $85.00 Figure 1.1 Figure 1.2 Figure 1.3 D es ire d S ea tD ep th

Frame Width

Seat Pan Growth

14"

14" - 16"

15"

15" - 16"

16"

16" - 18"

17"

17" - 18"

18"

18" - 20"

19"

19" - 20"

20"

20" - 22"

21"

21" - 22"

22"

NA

Figure 1.4

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a Option # HCPCS Definition Price a Option # HCPCS Definition Price o 12.5" o13.5" o 16.5" o 16.5" o16.5" o 17.0" o 17.0" o 17.0" o17.0" o 17.5" o 17.5" o 17.5" o 17" o17.5" o 18.0" o 18.0" o 18.0" o16.0" o 16.0" o 16.0" o16.5" o 16.5" o 16.5" o 16.5" o 16.5" o17.0" o 17.0" o 17.0" o 17.0" o 17.0" o17.5" o 17.5" o13.5" o o14.0" o o14.5" o 14.5" o15.0" o 15.0" o18.0" o 18.0" o 18.0" o 18.0" o 18.0" o o18.5" o 18.5" o 18.5" o 18.5" o 19.0" o 19.0" o 19.0" o 19.0" o 19.5" o16.0" o 16.0" o 16.0" o16.5" o 16.5" o 16.5" o 16.5" o 16.5" o17.0" o 17.0" o 17.0" o 17.0" o 17.0" o17.5" o 17.5" o17.0" o 17.0" o 17.0" o 17.0"

o17.5" o 17.5" o 17.5" o 17.5" 12" and 16" wheels not available with hand rims. o18.0" o 18.0" o 18.0" o 18.0" o 18.0" o

o18.5" o 18.5" o

o18.0" o 18.0" o 18.0" o 18.0" o o18.5" o 18.5" o 18.5" o 18.5"

o 19.0" o 19.0" o 19.0" o 19.0"

o 19.5" Not available on plastic coated. Only available with 24" rims. o o o o o o o

o Only available w/ 12" or 16" wheels. NA w/ one arm drive.

o o o

22" Mag Wheel

NA w/ projection handrims. Front Seat Height

o o

o 183RW3

o 183RW14

183HM2

One Arm Drive Small Handrim NA w/ 20" mag wheels

NC

Low Polyurethane

Only available w/ 12" Mag Wheel

Handrim 16" Mag

183RW1

Right Hand Mount

Rear Wheel Tire

NC

CASTER SIZE

8 Oblique Full Polyurethane

4. REAR WHEELS / SEAT HEIGHT

NC 183RT4

o

183RT3

Standard Axle Plate

NC One Arm Drive Axle Plate NA w/ 12"

& 16" mag, 24" spoke wheels.

183AX1 183AX17 183HR8 o 183AL17 E0958 183OA1 o 8x2" 22" Mag 5"

24" Mag & Spoke Rear Wheel Size

6" 12" Low Poly 4" 12" Mag 20" Mag 8x1" 8x1.5" NC Threaded Axles NA w/ 24" spoke wheels Axle Plate 183AL33 _o 183OA2 Axle

One Arm Drive Standard Handrim

$850.00 NC Projections NC 183HR7 Omit Handrim Plastic Coated NC 183RT2 E2213_E2211 Aluminum Anodized $95.00 183HR4 $80.00 NC 183HR1

o 183RT1 E2211_E2212 Pneumatic

o Pneumatic Airless Insert

183HM1

o

183HM2 Left Hand Mount NC

NC 183HM1

NC Left Hand Mount

NC

$100.00

Hub Lock

183LK01 12" Hub Lock $100.00

183LK02

Quick Release Axles NA w/ one arm drive

$325.00

Push to Lock NC

Attendant Wheel Lock (Foot Lock) NA w/ ext handles. NA w/ one arm drive

$80.00

Right Hand Mount NC

183WL10 NC E2206 E0961 NC o

5. WHEEL LOCKS / HUB LOCK

16" Hub Lock

183EH7

NC 12" Mag Wheel NA w/ hand rims

and full poly tires. With attendant wheel lock NA w/ +5 - 60° tilt angle.

NC

16" Mag Wheel NA w/ hand rims. Only avail w/pneumatic or pneumatic w/ airless inserts tires.

20" Mag Wheel NA w/ projection handrims. Wheel Lock Extension Handle 183WL8 24" Spoke Wheel 183RW8 24" Mag Wheel

Omit Wheel Lock

$65.00 NC NC Rear Wheel 183RW13 6" Pair 183RW51 $200.00 o 183WL41

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o o

o Multi-Adjustable Padded Hangers & Angle Adjustable Aluminum Footrests

o

o o

Select Extension Height Below for Short o o o o o NA w/ 12.5" seat height o o

Select Extension Height Below for Regular

o o o o o o o o o o

Footrests mount to extension tubes 1" Offset NA with -5-50 ° and -5-35° preset tilt angle and

o possible interference with 80 ° & 90 ° hangers

o o o o o o o o o o o o o o o o OR 183EP2

JAY FOOT BOXES

Center Mount 13.0" Extension Height NC 183EP1 NC 183MZ02 NC

80° Heavy Duty Front Mount Lift Off NA w/ 4" casters

90° Swing In/Swing Out -Front Mount

13.5" Extension Height 183EP10 NC 10.5" Extension Height NC NC 15.0" Extension Height 13.0" Extension Height 183EP8 NC NC NC 183FP02 NC -$15.00 $85.00 183EP5

A. Hanger Mounted Footrest

NC

Short $95.00

C. Contracture Footrest System

Only available with Swing Away, Lift-off Hangers , Adult Angle Adj Footplates and ELR / ALR.Single Foot Box pairs NA with 14"-15" frame widths. Full Foot Boxes NA with Heel Loop or Leg Strap, Tall Height Full Footbox w/ 14"-15" frame width and ELR / ALR. $185.00 183EP9 Omit Hanger Heel Loop 14.5" Extension Height o 183H159

Footrest (Choose ONE Option - A, B, or C)

183EP6 11.0" Extension Height $185.00 Outside Mount $95.00 183HL1 o o

Impact Guard Neoprene Only available w/ 60° or 70° ext. mount hanger

Standard Hanger Mount

K0038 183HL5

o

Additional Hanger and Footplate Options

183E25

NC 183HL6

183E26

183H32

Omit Single Leg Strap 11.5" Extension Height 183EP3 12.5" Extension Height 183EP5 183EP7 Footrest Options 14.0" Extension Height o $95.00 NC o 183E24 183H161 183F8

70° Heavy Duty Front Mount Lift Off

Composite

183EP6

A. Hanger Mounted Footrest Footplates

12.5" Extension Height

Omit Heel Loop 183HL4 Leg Strap 183IG2 183EP4 o o 183F1 E0990 183H147 183H140 183H158

90° Heavy Duty Front Mount Lift Off NA w/ 4" casters 183F5 NC Regular NC NC NC OR

183H26 Contracture Footrest System_{drop seat pan. NA w/ 15" frame depth}NA w/ 183FP01

80° Swing In/Swing Out -Front Mount

NC NC

12.0" Extension Height

E0951 70° Swing In/Swing Out -Front Mount

6. HANGER AND FOOTREST

o 183H132

80° Swing In/Swing Out NA w/ 8" casters

STD NC

B. Extension Tube Mounted Footrest Footplates

Aluminum Only available w/ELR o

183H142 183H146

NC 1" Offset Hanger Mount

K0053 Articulating HangerNA w/ Platform Flip Up and Alum Angle Adj Front Mount footplates.

B. Extension Tube Mounted Footrests

Short NC

$350.00

183E2

Elevating Hanger - Front Mount NA 90 ° footboard, some interference with casters if not tilted, 17" wide chairs & up.

NC $295.00

4" NA w/ 90 swing away, 90 lift off $55.00

Heel loop or leg strap not included, See Footplate Options Section

B. Extension Tube Mounted Footrests

$35.00

Hanger Mounts

$30.00 183MZ01

o

A. Hanger Mounted Footrest Extension Tubes

o 183E23 2"_hangersNA w/ 90 swing away, 90 lift off $55.00

183A7 Omit Footplate

Kids Angle Adj

Available w/ 14" to 16" frame width only 183F4

o

K0040

70° Swing In/Swing Out 183H139

Adult Angle Adj - Front Mount K0040

NC

183H145 60° Swing In/Swing Out NC

E0990 Elevating Hanger - Ext MountNA w/ Platform Flip Up and Alum Angle Adj Front Mount footplates.

$295.00 183H141

183H160

Medium

NA with 12.5" seat height NC 183E1

NC

STD o 183E16 K0037 High Mount Only available with_{adult or kids angle adj. footplates} $55.00

o 183E5

183F3 K0040 Adult Angle Adjustable - Ext Mount Long

NA with 12.5" seat height

NC $185.00

Single Foot Box

183JX03 Standard Height - Right

Tall Height - Pair

183JX01 Standard Height - Left $225.00

183JX02 Tall Height - Left $225.00

$225.00

183JX04 Tall Height - Right $225.00

183JX05 Standard Height - Pair $450.00

183JX06 $450.00

Full Foot Box

$325.00

Heel loop or leg strap not included, See Footplate Options Section

A

_C

A

B

A

B

A

B

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o o

o Only available with 40 degree tilt range. NA w/ 22" Deep Frame.

o

o o

Select desired Push Handle

o Select One

o

o AND Select desired Push Handle

o o o o o o o o

Mono Backrest System w/Dynamic Backrest

OR

o AND select desired Back Cane

183PH9 NC NC $850.00 7. BACKREST / SEATING E1225 NC 183B9 183MO1

D. Mono Back System

183B5

B. Height Adjustable Back w/ Adj. Stroller Handles

Mono Backrest System NC

JAY J3 Back

A. Stroller Handle Backpost (Fixed)

NC Low (18") JAY J3 Back NA w/ O2 Holder OR $85.00 183PH8 NC

Must select JAY J3 or JAY Custom Back when ordering Mono Back System.

o

183B201

Long Push Handle Recommended in combo w/ vent & battery tray Standard Push Handle

Standard 15"-21" 183B200 Tall 18"-24" 183BP13 NC 183MO2 Medium NC Tall C. Reclining Backrest (0-40°) 183BT21 Removable Extension NA w/

21"-22" frame width, height adj back with adj stroller handles

$395.00 $995.00 Reclining Backrest Tall (24") o 183BT101 183BP10 $1,195.00 Medium (21") NC o 183BP9 Dynamic Backrest NA w/ Reclining Backrest or 19"-22" seat depths See OF 183JB01 Dynamic Backrest 183BP11 o NC 183BQ06 -2" NC +2"

See FIGURE 1.5. The location of the backrest surface in relation to the front of the backpost. The measurement is taken from the front surface of the backpost to the deepest area of the backrest in contact with the user's body.

183BQ03 Flush 183BQ04 -1" 183BQ05 183BQ02 +1" NC NC NC NC

Backrest Position (set up by Quickie)

183BQ01 +3"

OR Backpost Style - (Choose ONE Option - A, B, C, or D)

183PH8 Standard Push Handle NC

NC

Reclining/Fixed Handle Ht. Diagram Height Adj. Handle Height Diagram Mono Height Adj. Handle Height Diagram

o 183PH9 Long Push Handle

A

B

C

D

Figure 1.5 ✔

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a Option # HCPCS Definition Price a Option # HCPCS Definition Price o o o o o o o o o o o o o o o o o o Some interference with armrest may exist when ordering a Backrest

with greater than 4" wider than the base. o

o o o o o o o o o o o o o o o o o o o o o 183JB04 NC SH Tall 24"

J3 PA Back (2.2" of Contour Depth) 14"-20" Wide

$745.00 J3 PDL Back (6.0" of Contour Depth)

14"-20" Wide

JAY J3 via JAY Your Way

UT Medium 18" shell height 183JB05

E2620

J3 PL Back (3.0" of Contour Depth) 14"-20" Wide

NC

UT Tall 19.5" shell height E2620 183JR07 NC 183JR09 o See OF JAY J3 Back Mono

183JP03

See OF JAY J3 Backrest Contour

183JP05 NC 183JQ03 18" Backrest Width o $795.00 E2615 SH Medium 22.5" NC

JAY J3 Backrest Width

183JQ02

183GZ03

Matching Frame- Standard Colors 183GZ02 183AA154 Black E0973 183JQ05 NC $250.00 183AA62 183AA48 183GZ01 o 183AA63 $265.00 Adjustable Locking Flip-Up

NC 20" Backrest Width

JAY J3 Back for Mono Backrest System

NC JAY J3 Backrest Color

E0973

Heavy Duty Option only available w/ Dual Post Armrest

Single Post Height Adjustable - Std

NA on HD, Vent/Battery Tray Base(LTV only), Reclining Backrest, Desk Length Armpads and Canopy.

NC

Mono Backrest Options ONLY

183JR12

183JQ04

$285.00 Single Post Height Adjustable - Low

Dual Post

Dual Post Height Adjustable

E1028

Full Length Contour

JAY J3 Back for Mono Backrest System Cont.

183AA29

E0973 E0973

7. BACKREST / SEATING (CONT)

183AA7 183AA43

E0973 183AA11

Select desired Headrest Mount (optional)

$295.00 NC

8. ARMREST / SIDE GUARDS

o

Dual Post Flip Back Height Adj

183AM22 183AM21 NC NC 183AM24 E0973 NC Desk Length Classic

Armpad

HeadsUp Sml: 3.5" Sht Arms HeadsUp Med: 4.1" Sht Arms

$310.00 E0955

Axys Mount & Bracket $230.00

NC $805.00 NC 183AA1 o E1028 E0955 $270.00 183AM23 $255.00

Foam Long Option for Length Adj Locking Flip Up

183AM10 $285.00

Length Adjustable Locking Flip-Up NA w/ Contour Armpad

E0973

Height Adj. Cantilever Armrest Available with Mono Back only. NA w/ 20",

o Foam Short_{Adj Locking Flip Up}Option for Length Desk Length Contour

Armrest

$95.00

Dual Post Flip Back Full Length Classic

183AM9 183MH15

183HE65

$200.00

o 183JR08 LAT 4X4 S/A MOUNTS includes 1" OFFSET - PR

LATERAL 4X4 W/ 1" OFFSET - PAIR 183ZV14 183HE66 183MH16 183MH17 183HE87 $745.00

Select desired Lateral (optional)

Adjust-A-Plush Standard E0955

NC

183HE82

SH Standard 21" Shell Height

$620.00

183HE88 JAY J3 Backrest Height

J3 PDC Back (6.0" of Contour Depth) 14"-20" Wide

183MH10

E1028

LATERAL SWING AWAY MOUNT - PAIR E0955

183HE83

o 183JP04

o

$535.00 J3 PA Back (2.2" of Contour Depth)

22" Wide E2613 o 183JP01 E2614 183JP02 Omit NC

Onyx Mount and Bracket E1028

Plush Head Support Pad 10" $230.00 Plush Head Support Pad 8" $230.00 Select desired Headrest Pad (optional)

Cobra Flip Back Mount and Bracket $280.00

E0955

HeadsUp Lrg: 5.3" Lng Arms $310.00 183HE78 E0955 Plush Head Support Pad 14" $230.00

$260.00 E0955

o Adjust-A-Plush Narrow

183HE89 E0955

UT Standard 16.5" shell height

$310.00

$260.00 o

o 183JR11

o 183JR10

LATERAL SWING AWAY MOUNT - PAIR LAT 4X5 S/A MOUNTS includes 1" OFFSET - PR

E0956

183ZS07 E1028

183ZS07

LAT 4X6 S/A MOUNTS includes 1" OFFSET - PR LATERAL 4X5 W/ 1" OFFSET - PAIR

o E1028

E0956 E1028 183ZS07

183ZS07

Matching Frame- Custom Color

NC NC $50.00 22" Backrest Width

$260.00

183ZV16 E0956 LATERAL 4X6 W/ 1" OFFSET - PAIR $260.00 $545.00 $805.00

183ZV15 $260.00

LAT 6X5 S/A MOUNTS includes 1" OFFSET - PR $805.00

183ZV18 E0956

LAT 6X4 S/A MOUNTS includes 1" OFFSET - PR $805.00 183ZV17 E0956 LATERAL 6X4 W/ 1" OFFSET - PAIR $260.00 $805.00 LATERAL SWING AWAY MOUNT - PAIR $545.00

183ZV07 E1028 LATERAL SWING AWAY MOUNT - PAIR $545.00 $545.00

LATERAL 6X5 W/ 1" OFFSET - PAIR $260.00 LATERAL SWING AWAY MOUNT - PAIR $545.00

E1028 LATERAL SWING AWAY MOUNT - PAIR $545.00

LAT 6X6 S/A MOUNTS includes 1" OFFSET - PR $805.00 183ZV19 E0956 LATERAL 6X6 W/ 1" OFFSET - PAIR $260.00 183ZS07 NC 183JQ06 183JQ01 NC 12" Backrest Width 14" Backrest Width 16" Backrest Width NC

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a Option # HCPCS Definition Price a Option # HCPCS Definition Price o o o o o o o o o o o o o o o

Included with vent tray option. Not ordered as separate line item.

o o o o o o o o o o o o o o o Not available with 12" and 16" mag wheels or projection handrims.

o

o o

o o Only available if armrests are included. NA with JAY Arm Troughs. o

o o

o Utility hook has weight a limit of 15 lbs.

183JN04 E1028 Swing Away - Rotational (Pair) $500.00

183JN02 E1028 Swing Away - Rotational (EA) $250.00

JAY Arm Trough - Hardware

$205.00 183JL08

183JN03 Fixed (Pair) NC

E2209 Arm Trough - 18" long - Pair

$410.00 $410.00

E2209 Arm Trough - 22" long - Pair

183JN01 Fixed (EA) NC

183JL03 E2209 Arm Trough - 22" long - Left 183JL09

E2209 Arm Trough - 22" long - Right $205.00 Arm Trough - 18" long - Left $205.00 183JL06

183JL01

$205.00 183JL07

183JL02 E2209

JAY Arm Troughs

Arm Trough - 14" long - Pair

Padded Trunk Strap - XL $187.00

183JA03 Padded Trunk Strap - Large

$187.00 $187.00 $187.00 Padded Trunk Strap - Medium

183JA01 Padded Trunk Strap - Small

183JZ03

183JA02

Large X-Large Arm Trough - 18" long - Right

JAY Padded Trunk Strap

NC Medium $187.00 $187.00 $187.00 $205.00

JAY Anterior Thoracic Support

183JY01

Small 183JY02

NC E2209 Arm Trough - 14" long - Right $205.00

NC Arm Trough - 14" long - Left

NA with Length Adj. Locking Flip Up and Adj Locking Flip Up armrests and Single Post Height Adj Armrests. F ull Lentgh Classic Armpads will automatically be selected when chosing only one side Arm Trough.

Contour Structure Style 183JY03 Classic Dynamic $187.00 183A158 183JZ04 E0971 183JZ02 E2209 183JL05

183A1 Black Utility Backpack

$495.00

$45.00

IV Pole

NA w/ Mono Back 183A82

183A8 Black Seat Pouch

183A701 183JY04 2" Dual Pull Squeeze Pad w/Clamp

Positioning Belt

Vent Tray - Back Cane Mount

183A118

2" Aircraft Buckle w/Clamps E0978 1.5" Auto Buckle Universal w/Clamp

183JZ01

183A117 E0978

Anti Tips (Pair)

Anti Tips 183SG4 183A141 $85.00 $140.00 $110.00

9. KEY OPTIONS AND ACCESSORIES

Black NA w/ projection handrims 183A120

E0950

Positioning Belt Clamps Only

183A23 $250.00 183A31 Spoke Guards 183A24 Medium (15"-17")

Center Opening with Buckle Size $70.00 $120.00 K0108 K0065 o 183A601 Large (18"-20") $250.00 $50.00 $250.00

Wheelchair Tray Table

o 183LF12

$115.00

$150.00 $45.00

$275.00 O2 Holder NA w/ Height Adj Stroller

Handles. NA w/ Reclining Backrest, Mono Back

$55.00

E1029

Dovetail Vertical Frame Mounted Hardware for LTV Ventilators includes 1 utility hook 2" Aircraft Buckle Pad w/Clamp

183JY05 $187.00 E0950 Classic Structure Contour Dynamic E2209

8. ARMREST / SIDE GUARDS (CONT)

$410.00 183JL04 E2209 o 183LF13 183SG3 K0108 Plastic Regular Side Guard

Only available w/ length adj locking flip-up, adj locking flip-up and armrest styles. NA w/ Mono Back. E0978 $125.00 Plastic Kids $125.00 NC 183JA04 $115.00 Miscellaneous Accessories o

183A54 Extra Leg Strap Black $30.00

Dovetail Vertical Frame Mounted Hardware for Trilogy Ventilators includes 1 utility hook

Caddy Only available w/ extention tube mounted footrests

E2208 o K0105 E1029 E0978 K0065 Clear

183A30 E0950 Small (13"-14")

$495.00 183A33 E0950 X-Large (21"-22")

K0108

183AT1

Canopy (SunShade)

183A32

$250.00

Need 2" back post clearance to mount canopy hardware. May require next

5 1/4" Classic Pad 8" LOW STD 6 3/4" to 10 3/4" Armrest Size Receiver

Pad Length L Pad Length L Full 10 1/2" 8 3/4" to 13 3/4" Desk Receiver H Range Transfer Tube Length D

Armrest Matrix for Single Post

H Range 14" STD 10 3/4" to 15 3/4" STD 9" to 13" Contour Pad LOW LOW 14 1/4" 10 1/4" 7 1/4" to 11 1/4" 10" to 15" 8 1/2" to 12 1/2" STD LOW Full 8 1/4" to 12 1/2" LOW Desk STD

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a Option # HCPCS Definition Price a Option # HCPCS Definition Price o NC o NC o o NC o NC o o NC o NC o o NC o NC o NC o NC o NC o NC o NC o NC o NC o NC o NC o NC o NC o

o Commonly Requested Options Include:

o  23" & 24" Seat Widths

o  Angle Adjustable Handle for Reclining Backrest

o  Frog Legs

 Longer Wheel Lock Extensions

 Reverse Configuration

 Dual Mount Wheel Locks - Attendant Foot Lock

 Dynamic Back on Frame Depth up to 20"

183C152 Matte Purple NC

183C149 Matte Evergreen NC

183C116

183C150 Matte Electric Blue NC

Matte Black NC

183C151 Matte Black Cherry NC

Matte Frame Color

183C143 Evergreen

Additional Options Through Built for Me

183C142 Electric Blue 183C8 Yellow _{To inquire about any unique customization for Quickie products, contact: Phone:}

(800) 333-4000, Fax: (800) 333 9011

183C35 Candy Red 183C113 Titanium

183C14 Candy Purple 183C145 Sunrise Orange

Black 183C144

Zebra(Choose above base color) Std with White unless above base paint is chosen NA w/ Black

$295.00

183C36 Candy Blue 183C114 Sparkle Silver

183C10 Mauve Pink

o 183C108

183C38 Blue Opal 183C103 Rootbeer

Black Opal 183C148

$295.00

183C141 Black Cherry 183C147 Hot Sparkle Pink 183C42 Stars & Stripes $295.00

183C43

183C2 Green Apple Mossy Oak Camouflage

183C112 Desert Camouflage $295.00

183C140 Aztec Gold 183C126 Glow

10. COLOR

Standard Frame Color Custom Frame Color

11. APPENDIX Lower Leg Length Matrix

Front seat height must be at least 2" taller than lower leg length on all swing in/out hangers. Front seat height must be at least 2" taller than maximum lower leg length on all front mount hangers.

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a Option # HCPCS Definition Price a Option # HCPCS Definition Price o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o

JAY

®

Signature Series Backrest and Accessories

Note: Not all sizes and configurations shown below, for full offering visit www.sunrisemedical.com

When ordering mark the part number desired and it will be added to the order as a separate line item .

JAY BACKREST

JAY J3 Back PA (2.2" Contour Depth) JAY J3 Back PL (3" Contour Depth)

MT Shells- 4 Point Standard Hardware MT Shells- 4 Point Standard Hardware

J3PAMTT12FS E2613 12" Wide J3 Back w/ 15" Shell Height $580.00 J3PLMTT12FS E2613 12" Wide J3 Back w/ 15" Shell Height $670.00 J3PAMTT14FS E2613 14" Wide J3 Back w/ 15" Shell Height $580.00 J3PLMTT14FS E2613 14" Wide J3 Back w/ 15" Shell Height $670.00 J3PAMTT16FS E2613 16" Wide J3 Back w/ 15" Shell Height $580.00 J3PLMTT16FS E2613 16" Wide J3 Back w/ 15" Shell Height $670.00 J3PAMTT18FS E2613 18" Wide J3 Back w/ 15" Shell Height $580.00 J3PLMTT18FS E2613 18" Wide J3 Back w/ 15" Shell Height $670.00 J3PAMTT20FS E2613 20" Wide J3 Back w/ 15" Shell Height $580.00 J3PLMTT20FS E2613 20" Wide J3 Back w/ 15" Shell Height $670.00

UT Shells- 4 Point Standard Hardware UT Shells- 4 Point Standard Hardware

J3PAUTS12FS E2613 12" Wide J3 Back w/ 16.5" Shell Height $580.00 J3PLUTS12FS E2613 12" Wide J3 Back w/ 16.5" Shell Height $670.00 J3PAUTS14FS E2613 14" Wide J3 Back w/ 16.5" Shell Height $580.00 J3PLUTS14FS E2613 14" Wide J3 Back w/ 16.5" Shell Height $670.00 J3PAUTS16FS E2613 16" Wide J3 Back w/ 16.5" Shell Height $580.00 J3PLUTS16FS E2613 16" Wide J3 Back w/ 16.5" Shell Height $670.00 J3PAUTS18FS E2613 18" Wide J3 Back w/ 16.5" Shell Height $580.00 J3PLUTS18FS E2613 18" Wide J3 Back w/ 16.5" Shell Height $670.00 J3PAUTS20FS E2613 20" Wide J3 Back w/ 16.5" Shell Height $580.00 J3PLUTS20FS E2613 20" Wide J3 Back w/ 16.5" Shell Height $670.00 J3PAUTM14FS E2613 14" Wide J3 Back w/ 18" Shell Height $580.00 J3PLUTM14FS E2613 14" Wide J3 Back w/ 18" Shell Height $670.00 J3PAUTM16FS E2613 16" Wide J3 Back w/ 18" Shell Height $580.00 J3PLUTM16FS E2613 16" Wide J3 Back w/ 18" Shell Height $670.00 J3PAUTM18FS E2613 18" Wide J3 Back w/ 18" Shell Height $580.00 J3PLUTM18FS E2613 18" Wide J3 Back w/ 18" Shell Height $670.00 J3PAUTM20FS E2613 20" Wide J3 Back w/ 18" Shell Height $580.00 J3PLUTM20FS E2613 20" Wide J3 Back w/ 18" Shell Height $670.00 J3PAUTM22FS E2614 22" Wide J3 Back w/ 18" Shell Height $795.00 J3PLUTT14FS E2613 14" Wide J3 Back w/ 19.5" Shell Height $670.00 J3PAUTT14FS E2613 14" Wide J3 Back w/ 19.5" Shell Height $580.00 J3PLUTT16FS E2613 16" Wide J3 Back w/ 19.5" Shell Height $670.00 J3PAUTT16FS E2613 16" Wide J3 Back w/ 19.5" Shell Height $580.00 J3PLUTT18FS E2613 18" Wide J3 Back w/ 19.5" Shell Height $670.00 J3PAUTT18FS E2613 18" Wide J3 Back w/ 19.5" Shell Height $580.00 J3PLUTT20FS E2613 20" Wide J3 Back w/ 19.5" Shell Height $670.00 J3PAUTT20FS E2613 20" Wide J3 Back w/ 19.5" Shell Height $580.00 SH Shells- 4 Point Standard Hardware

SH Shells- 4 Point Standard Hardware J3PLSHS14FS E2613 14" Wide J3 Back w/ 21" Shell Height $670.00

J3PASHS14FS E2613 14" Wide J3 Back w/ 21" Shell Height $580.00 J3PLSHS16FS E2613 16" Wide J3 Back w/ 21" Shell Height $670.00 J3PASHS16FS E2613 16" Wide J3 Back w/ 21" Shell Height $580.00 J3PLSHS18FS E2613 18" Wide J3 Back w/ 21" Shell Height $670.00 J3PASHS18FS E2613 18" Wide J3 Back w/ 21" Shell Height $580.00 J3PLSHS20FS E2613 20" Wide J3 Back w/ 21" Shell Height $670.00 J3PASHS20FS E2613 20" Wide J3 Back w/ 21" Shell Height $580.00 J3PLSHM16FS E2613 16" Wide J3 Back w/ 22.5" Shell Height $670.00 J3PASHS22FS E2614 22" Wide J3 Back w/ 21" Shell Height $795.00 J3PLSHM18FS E2613 18" Wide J3 Back w/ 22.5" Shell Height $670.00 J3PASHM16FS E2613 16" Wide J3 Back w/ 22.5" Shell Height $580.00 J3PLSHM20FS E2613 20" Wide J3 Back w/ 22.5" Shell Height $670.00 J3PASHM18FS E2613 18" Wide J3 Back w/ 22.5" Shell Height $580.00 J3PLSHT18FS E2613 18" Wide J3 Back w/ 24" Shell Height $670.00 J3PASHM20FS E2613 20" Wide J3 Back w/ 22.5" Shell Height $580.00 J3PLSHT20FS E2613 20" Wide J3 Back w/ 24" Shell Height $670.00 J3PASHT18FS E2613 18" Wide J3 Back w/ 24" Shell Height $580.00

J3PASHT20FS E2613 20" Wide J3 Back w/ 24" Shell Height $580.00

JAY J3 Back PD (6" Contour Depth)

MT Shells- 4 Point Standard Hardware UT Shells- 4 Point Standard Hardware Continued

J3PDMTT14FS E2620 14" Wide J3 Back w/ 15" Shell Height $795.00 J3PDUTM18FS E2620 18" Wide J3 Back w/ 18" Shell Height $750.00 J3PDMTT16FS E2620 16" Wide J3 Back w/ 15" Shell Height $750.00 J3PDUTM20FS E2620 20" Wide J3 Back w/ 18" Shell Height $750.00 J3PDMTT18FS E2620 18" Wide J3 Back w/ 15" Shell Height $750.00 SH Shells- 4 Point Standard Hardware

J3PDMTT20FS E2620 20" Wide J3 Back w/ 15" Shell Height $750.00 J3PDSHS14FS E2620 14" Wide J3 Back w/ 21" Shell Height $750.00

UT Shells- 4 Point Standard Hardware J3PDSHS16FS E2620 16" Wide J3 Back w/ 21" Shell Height $750.00

J3PDUTM14FS E2620 14" Wide J3 Back w/ 18" Shell Height $750.00 J3PDSHS18FS E2620 18" Wide J3 Back w/ 21" Shell Height $750.00 J3PDUTM16FS E2620 16" Wide J3 Back w/ 18" Shell Height $750.00 J3PDSHS20FS E2620 20" Wide J3 Back w/ 21" Shell Height $750.00

JAY J3 Back Headrest

AXYS Mount and Pad LINX Mount and Pad

J3HEDX8 E0955/E1028 AXYS Headrest with 8" Plush Pad $381.00 J3HEDL8 E0955/E1028 LINX Headrest with 8" Plush Pad $441.00 J3HEDX10 E0955/E1028 AXYS Headrest with 10" Plush Pad $381.00 J3HEDL10 E0955/E1028 LINX Headrest with 10" Plush Pad $441.00 J3HEDX14 E0955/E1028 AXYS Headrest with 14" Plush Pad $394.00 J3HEDL14 E0955/E1028 LINX Headrest with 14" Plush Pad $454.00 J3HEDXAAPN E0955/E1028 AXYS with Adj-a-Plush Narrow Pad $480.00 J3HEDLAAPN E0955/E1028 LINX with Adj-a-Plush Narrow Pad $540.00

SwingAway Lat with 6"x4" Pad (PR) J3HEDXAAPS E0955/E1028 AXYS with Adj-a-Plush Std Pad $480.00 J3HEDLAAPS E0955/E1028

$778.00 LINX with Adj-a-Plush Std Pad $540.00

JAY J3 Back LateralsSwing Away Laterals With Pad - Pair

J3LAT4X4SA E0956/E1028 SwingAway Lat with 4"x4" Pad (PR) $778.00 J3LAT6X4SA E0956/E1028 $778.00

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a Option # HCPCS Definition Price a Option # HCPCS Definition Price o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o o

JAY

®

Signature Series Cushions

Note: Not all sizes and configurations shown below, for full offering visit www.sunrisemedical.com.

When ordering mark the part number desired and it will be added to the order as a separate line item .

JAY CUSHIONS

JAY Fusion Cushion JAY J2 Cushion

JFUSION1416 E2622 JAY Fusion 14" x 16" $440.00 2108-MJ E2622 JAY J2 14" x 16" $435.00

JFUSION1616 E2622 JAY Fusion 16" x 16" $440.00 2105-MJ E2622 JAY J2 15.5" x 16" $435.00

JFUSION1818 E2622 JAY Fusion 18" x 18" $440.00 2101 E2622 JAY J2 18" x 18" $435.00

JAY J2 20" x 18" $470.00

JFUSION1820 E2622 JAY Fusion 18" x 20" $440.00 2103-MJ E2622

2102-MJ E2622

JAY J2 18" x 20" $470.00

JFUSION2018 E2622 JAY Fusion 20" x 18" $440.00 2118-MJ E2622

JAY J2 20" x 20" $545.00 JFUSION2220 E2623 JAY Fusion 22" x 20" $540.00

JFUSION2020 E2622 JAY Fusion 20" x 20" $440.00

JAY Fusion Cushion w/ ROHO Single Valve Air Insert JAY J2 Deep Contour Cushion

JFUSION1416AS E2622 JAY Fusion 14" x 16" $440.00 2446 E2622 JAY J2 Deep Contour 14" x 16" $450.00 JFUSION1616AS E2622 JAY Fusion 16" x 16" $440.00 2466 E2622 JAY J2 Deep Contour 16" x 16" $450.00 JFUSION1618AS E2622 JAY Fusion 16" x 18" $440.00 2468 E2622 JAY J2 Deep Contour 16" x 18" $450.00 JFUSION1620AS E2622 JAY Fusion 16" x 20" $440.00 2460 E2622 JAY J2 Deep Contour 16" x 20" $480.00 JFUSION1717AS E2622 JAY Fusion 17" x 17" $440.00 2477 E2622 JAY J2 Deep Contour 17" x 17" $450.00 JFUSION1816AS E2622 JAY Fusion 18" x 16" $440.00 2486 E2622 JAY J2 Deep Contour 18" x 16" $450.00 JFUSION1818AS E2622 JAY Fusion 18" x 18" $440.00 2488 E2622 JAY J2 Deep Contour 18" x 18" $450.00 JFUSION1820AS E2622 JAY Fusion 18" x 20" $440.00 2480 E2622 JAY J2 Deep Contour 18" x 20" $480.00 JFUSION2018AS E2622 JAY Fusion 20" x 18" $440.00 2408 E2622 JAY J2 Deep Contour 20" x 18" $480.00 JFUSION2020AS E2622 JAY Fusion 20" x 20" $440.00 2400-MJ E2622 JAY J2 Deep Contour 20" x 20" $555.00 JFUSION2220AS E2623 JAY Fusion 22" x 20" $540.00 2428 E2623 JAY J2 Deep Contour 22" x 18" $555.00

JAY Fusion Cushion w/ ROHO Dual Valve Air Insert JAY X2 Cushion

JFUSION1416AD E2622 JAY Fusion 14" x 16" $440.00 JX21416 E2622 JAY X2 14" x 16" $425.00

JFUSION2020AD E2622 JAY Fusion 20" x 20" $440.00 JFUSION2220AD E2623 JAY Fusion 22" x 20" $540.00

JAY Union Cushion JAY Ion Cushion

JU1416 E2607 JAY UNION 14" x 16" $445.00 JION1416 E2607 JAY ION 14" x 16" $395.00