q q q q q q q - Ki Mobility · Seat Pan q Removable Aluminum Seat Pan E2231 _____ $245 Not...
13
Company: ________________________________________________ Account Number: __________________ Date: _________________ q Quote q PO Number: ___________________________________ RTS: _____________________________________________________ Marked For: _______________________________________________ Ship To: __________________________________________________ Address: _________________________________________________ City: ________________________________ State: _____________ Zip: ________________ Phone: _____________________________ Email/Fax: ________________________________________________ HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions. Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer’s coverage policy. Frame Frame Width / Frame Depth Transit Option q Transit System K0108 ______________________________________________________________________ $320 No charge when selected with Spark - Transit Included. Not available with Removable Seat Pan. q Spark - Transit Included E1238 ___________________________________ $2370 165 lb weight capacity. Not available with upholstery. q Spark - Transit Not Included E1238 _________________________ $2050 165 lb weight capacity. Not available with upholstery. Backrest Back Post / Height Range / Back Height Select Back Height in row corresponding to desired Back Post and Height Range. Both Back Post options are folding and angle adjustable in 4º increments. Back Post Price Height Range Back Height Standard Depth Adjustable N/C Short q 20 Tall q 24 Height Adjustable Depth Adjustable $75 Short 1 q 13 q 14 q 15 q 16 q 17 Medium q 16 q 17 q 18 q 19 q 20 Tall q 20 2 q 21 q 22 q 23 q 24 1 Not available with Seating Dynamics Rocker Back 2 Not available with Angle Adjustable Locking Extendable Flip Up Armrest Back Post Options q Stroller Handle Extensions ______________________________________________________________ $75 Not available with Height Adjustable Depth Adjustable Back Posts q Seating Dynamics Rocker Back K0108 __________________________________ $1995 Available only with T-Arms. Not available with 12” Frame Depths with Rear Frame Heights lower than 14.5”. Phone (800) 981-1540 | Fax (715) 254-0996 [email protected] | www.kimobility.com Select box corresponding to desired Frame Width and Depth. See references at right. Frame Width 10” 11” 12” 13” 14” 15” 16” Frame Depth 12” q q q q q q q 13” q q q q q q q 14” q q q q q q q 15” q q q q q q q 16” q q q q q q q 17” q q q q q q q 18” q q q q q q q Frame Width Spark is set up to allow 2” increase in frame width from initial frame width in 1” increments. Growth is achieved by expanding cross braces. 16” maximum frame width. 10” Frame Width expands only 1”. Frame Depth Spark is set up to allow 4” increase in frame depth from initial frame depth in 1” increments. 19” maximum frame depth. Wheelchair Drive Ready Chair will ship from Ki Mobility with adaption kit installed for selected Alber system. Order system separately from Alber USA. Select Rear Frame Height (full profile selections only) in drive wheel size on Rear Frame Height chart (page 4). Requires Rear Anti-Tips. Not available with Spinergy wheel. q e-motion Ready __________________________________________________________________________________ N/C q twion Ready _________________________________________________________________________________________ N/C DCN0033.28 Pricing and specifications subject to change without notice Page 1 of 13 This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Seat Pan q Removable Aluminum Seat Pan E2231 _____________________________________ $245 Not available with Transit System. Pan depth 1/2” shorter than Frame Depth. Effective 04/08/2019 Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________
Transcript of q q q q q q q - Ki Mobility · Seat Pan q Removable Aluminum Seat Pan E2231 _____ $245 Not...
Company: ________________________________________________
Account Number: __________________ Date: _________________
q Quote q PO Number: ___________________________________
RTS: _____________________________________________________
Marked For: _______________________________________________
Ship To: __________________________________________________
Address: _________________________________________________
City: ________________________________ State: _____________
Zip: ________________ Phone: _____________________________
Email/Fax: ________________________________________________
HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions.
Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer’s coverage policy.
Frame
Frame Width / Frame Depth
Transit Option
q Transit System K0108 ______________________________________________________________________ $320No charge when selected with Spark - Transit Included. Not available with Removable Seat Pan.
q Spark - Transit Included E1238 ___________________________________ $2370165 lb weight capacity. Not available with upholstery.
q Spark - Transit Not Included E1238 _________________________ $2050165 lb weight capacity. Not available with upholstery.
Backrest
Back Post / Height Range / Back HeightSelect Back Height in row corresponding to desired Back Post and Height Range. Both Back Post options are folding and angle adjustable in 4º increments.
BackPost
Price Height Range
Back Height
Standard Depth Adjustable
N/CShort q 20
Tall q 24
Height Adjustable Depth Adjustable
$75
Short1 q 13 q 14 q 15 q 16 q 17
Medium q 16 q 17 q 18 q 19 q 20
Tall q 202 q 21 q 22 q 23 q 241 Not available with Seating Dynamics Rocker Back2 Not available with Angle Adjustable Locking Extendable Flip Up Armrest
Back Post Options
q Stroller Handle Extensions ______________________________________________________________ $75Not available with Height Adjustable Depth Adjustable Back Posts
q Seating Dynamics Rocker Back K0108 __________________________________ $1995Available only with T-Arms. Not available with 12” Frame Depths with Rear Frame Heights lower than 14.5”.
Phone (800) 981-1540 | Fax (715) [email protected] | www.kimobility.com
Select box corresponding to desired Frame Width and Depth.See references at right.
Frame Width
10” 11” 12” 13” 14” 15” 16”
Fram
e D
epth
12” q q q q q q q13” q q q q q q q14” q q q q q q q15” q q q q q q q16” q q q q q q q17” q q q q q q q18” q q q q q q q
Frame WidthSpark is set up to allow 2” increase in frame width from initial frame width in 1” increments. Growth is achieved by expanding cross braces. 16” maximum frame width. 10” Frame Width expands only 1”.
Frame DepthSpark is set up to allow 4” increase in frame depth from initial frame depth in 1” increments. 19” maximum frame depth.
Wheelchair Drive ReadyChair will ship from Ki Mobility with adaption kit installed for selected Alber system. Order system separately from Alber USA. Select Rear Frame Height (full profile selections only) in drive wheel size on Rear Frame Height chart (page 4). Requires Rear Anti-Tips. Not available with Spinergy wheel.
q e-motion Ready __________________________________________________________________________________ N/Cq twion Ready _________________________________________________________________________________________ N/C
DCN0033.28 Pricing and specifications subject to change without notice Page 1 of 13
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows.
Seat Pan
q Removable Aluminum Seat Pan E2231 _____________________________________ $245Not available with Transit System. Pan depth 1/2” shorter than Frame Depth.
Effective 04/08/2019
Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________
Footrest
Hanger / Front Frame Bend
q 60º __________________________________________________________________________________________________________ N/CAvailable only with Extension Tube Hangers
q 70º __________________________________________________________________________________________________________ N/Cq 80º __________________________________________________________________________________________________________ N/C
Not available with 7” or 8” Casters
q 90º __________________________________________________________________________________________________________ N/CAvailable only with Front Mount Hangers. Not available with 7” or 8” Casters.
q Pediatric Pro Elevating Leg Rests (Peds PRO ELR) E0990 New!___ $295q Pro Elevating Leg Rests (PRO ELR) E0990 _______________________________ $295
Not available with Seat Widths less than 14”
q Omit Hangers ___________________________________________________________________________________ - $20
Footplate
q Composite ____________________________________________________________________________________________ N/CNot available with Front Mount Hanger, Frame Widths less than 14” or PRO ELR
q Composite Angle Adjustable K0040 ___________________________________________ $185Not available with Front Mount Hanger or Frame Widths less than 15”
q Aluminum Angle Adjustable K0040 _____________________________________________ $185q Aluminum Locking Multi-Angle Adjustable K0108 New! ____ $300
Available only with Front Mount Hanger
q One Piece Flip Up Angle Adjustable K0040 ______________________________ $190Not available with Front Mount Hanger, PRO ELR or Frame Widths less than 14”
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Footrest / Extension / Seat to Footrest Length
Minimum Front Seat Height with Front Mount Hangers
Hanger Length Short Medium Long
Hanger Bend 70º 80/90º 70º 80/90º 70º 80º
Minimum Front Seat Height with Standard Selection
13” 13.5” 14” 15” 16” 17”
Minimum Front Seat Height with 3” Extension
14.5” 16” 16.5” 18” 18.5” 20”
3” ExtensionAvailable only with Front Mount Hangers. Provided as parts.
q 3” Extension for Front Mount Hanger __________________________________________ $55
DCN0033.28 Pricing and specifications subject to change without notice Page 2 of 13
Hanger ReleaseIf no selection is made Classic Hanger Release will be used
q Classic ____________________________________________________________________________________________________ Stdq 4-Way - In line _____________________________________________________________________________________ N/C
See reference A below. Not available with PRO ELR or Peds PRO ELR.
q 4-Way - Out _________________________________________________________________________________________ N/CSee reference B below. Not available with PRO ELR or Peds PRO ELR.
A B
Select Seat to Footrest Length in row corresponding to desired Footrest and Extension. Footrest Length of at least 2.5” shorter than Front Seat Height recommended. Extension Tube Hanger measurements are based on 70º Hanger / Front Frame Bend.
Footrest Extension Seat to Footrest Length
Extension TubeHangers(60º, 70º, 80º)
Short q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15
Medium q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17
Long q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5
Front Mount Hangers 1
Standard Selections Requires 3” Extension for $55
Short(70º, 80º, 90º)
q 5 q 5.5 q 6 q 6.5 q 7 q 10 q 10.5 q 11
q 7.5 q 8 q 8.5 q 9 q 9.5 q 11.5 q 12 q 12.5
Medium(70º, 80º, 90º)
q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 12 q 12.5 q 13
q 8.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5 q 13.5 q 14 q 14.5
Long(70º, 80º)
q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 8.5 q 9 q 14 q 14.5 q 15
q 9.5 q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 15.5 q 16 q 16.5
Peds 2
PRO ELR
Low Pivot q 7.5 3 q 8 3 q 8.5 4 q 9 4 q 9.5 4 q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13
High Pivot q 6 3 q 6.5 3 q 7 4 q 7.5 4 q 8 4 q 8.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5
PRO ELR Low Pivot Setting
Short q 12 - 17.5
Long q 15 - 21
PRO ELR High Pivot Setting
Short q 10.5 - 15.5
Long q 13 - 191 See Minimum Front Seat Height chart below.2 Comes standard with 3” Extension3 Not avalable on chairs 13” wide or more4 Not avalable on chairs 15” wide or more
Front Frame Height and Casters
Caster Type
q .75” Rollerblade __________________________________________________________________________________ N/CAvailable only with 3” and 4” Caster Sizes
q .75” Lighted Rollerblade __________________________________________________________________ $70Available only with 3”, 4” and 5” Caster Sizes
q 1” Poly ___________________________________________________________________________________________________ N/CNot available with 3” Caster Size
q 1” Poly Aluminum _____________________________________________________________________________ $110Available only with 4” and 5” Caster Sizes
q 1” Pneumatic _______________________________________________________________________________________ $85Available only with 6” and 8” Caster Sizes
q 1.5” Poly _______________________________________________________________________________________________ $50Available only with 4”, 5” and 6” Caster Sizes
q 1.5” Soft Roll Aluminum _________________________________________________________________ $175Not available with 7” and 8” Caster Sizes
q 2” Poly ___________________________________________________________________________________________________ $70Available only with 6” Caster Size
q 2” Pneumatic w/ Foam Insert ______________________________________________________ $225Available only with 8” Caster Size
Caster Size / Front Frame Type / Front Frame Height
Fork Options
Fork Stem
q Best Fit ___________________________________________________________________________________________________ StdKi Mobility will pick Fork and Stem combination to optimize performance based on Caster Size and Front Seat Height
q Standard Fork Stem __________________________________________________________________________ N/Cq 3/4” Longer Fork Stem ____________________________________________________________________ N/Cq 1 1/2” Longer Fork Stem _________________________________________________________________ N/C
q Frog Legs Ultra-Sport Fork - Black ____________________________________________ $425Available only with 3”, 4”, 5” or 6” Caster Sizes. Not available with Caster Pin Locks, 2” Poly Caster Type or 2” Pneumatic w/ Foam Insert Caster Type.
End User Weight Required: ____________ lbs
q Caster Pin Locks K0073 _________________________________________________________________ $195Not available with Performance Caster Housing, 1 1/2” Longer Fork Stem or Frog Legs Fork
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0033.28 Pricing and specifications subject to change without notice Page 3 of 13
Select Front Frame Height in row corresponding to desired caster size. Selections in first three columns require Super Low Front Frame.
Caster Size
Front Frame HeightRequires Super Low Front Frame1
3” q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5
4” q 13.52 q 14 q 14.5 q 153 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20
5” q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
6” q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
7” q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
8” q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.51 Price is $502 Front Frame Height not available with 4 x 1” Poly Caster3 Super Low Front Frame required when using 4 x 1” Poly Caster
Caster Housing
q Standard _______________________________________________________________________________________________ N/Cq Performance ________________________________________________________________________________________ $35
Heel LoopNot available with One Piece Flip Up Angle Adjustable Footplate or Frame Widths less than 14”
q Heel Loops E0951 ______________________________________________________________________________ $30q Adjustable Heel Loops E0951 ________________________________________________________ $50q Omit Heel Loops ________________________________________________________________________________ N/C
Calf Strap
q Velcro Adjustable K0038 ___________________________________________________________________ $35q Padded Velcro Adjustable K0038 __________________________________________________ $68q Bodypoint Padded AeroMesh K0038 _________________________________________ $102
Footrest continued
Maximum Seat Dump Reference(Front Seat Height minus Rear Seat Height)
Seat Depth 12” 13” 14” 15” 16” 17” 18” 19”Maximum Dump Standard Caster Housing 1.5” 1.5” 1.5” 2” 2” 2” 2.5” 2.5”Maximum Dump Performance Caster Housing 2.5” 2.5” 3” 3” 3” 3.5” 3.5” 4”
Residual Limb SupportResidual Limb Support E1020
q Left ____________________________ $395 q Right _____________________________ $395
q Omit Left Hanger ___- $10 q Omit Right Hanger ____ - $10
Cover q Smooth q Air Mesh q Smooth q Air Mesh
Pad Size q 5 x 8 q 9 x 14 q 5 x 8 q 9 x 14
q 7 x 10 q 11 x 10 q 7 x 10 q 11 x 10
q 9 x 10 q 11 x 14 q 9 x 10 q 11 x 14
Rear Wheel Type
q Spoke __________________________________________________________________________________________________ $100q MAXX Performance Spoke New! _____________________________________________ $200
Available only in 22” and 24” wheel sizes
q Mag (Black) __________________________________________________________________________________________ N/CNot available in 18” wheel size
Colored Mag ____________________________________________________________________________________________ $100Available only in 20” and 22” wheel sizes
Color: q Florescent Red q White q Blue q Pink
Spinergy Spox _________________________________________________________________________________________ $820Not available in 18” or 20” wheel sizes
Color: q Black q Red q White q Blue q Yellow
Handrim: q Short Tab q Long TabAvailable only with Aluminum Anodized and Plastic Coated Handrims
Rear Tire Type
q Street Pneumatic 1 3/8” E2211, E2212 ___________________________________________ Stdq Full Poly 1 3/8” E2218 _______________________________________________________________________ $55q Pneumatic with Airless Insert 1 3/8” E2211, E2213 ____________________ $95
Handrim
Handrim Option
q 3M Micro Grip _____________________________________________________________________________________ $65Not available on Plastic Coated or Projection Handrims
Axle Plate
q Low Poly 1” E2218 _____________________________________________________________________________ $55q Sentinel Solid Tire 1” E2218 ____________________________________________________________ $95
Not available on 18” wheel size or 20” and 22” Mag wheels
q High Pressure 1” E2211, E2212 ________________________________________________________ $95Not available on Mag wheel or 18” wheel size
Full Profile
Rear Frame Height and Wheels
Wheel Size / Tire Profile / Rear Frame Height
Low Profile
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
q Aluminum Anodized ___________________________________________________________________________ Stdq Plastic Coated _____________________________________________________________________________________ $95q Projection (8 Vertical Projections) ________________________________________________ $295
Available only with full profile tires in combination with MAXX Performance, 22”-24” Spoke, or 24” Mag wheel
q Omit Handrim ______________________________________________________________________________________ N/C
Not available on 18” or 20” wheel sizes or 22” Mag wheel. Not recommended with Mag wheel.
q Natural Fit LT Regular Grip ____________________________________________________________ $445q Natural Fit Standard Regular Grip _______________________________________________ $445q Natural Fit LT Super Grip _______________________________________________________________ $495q Natural Fit Standard Super Grip __________________________________________________ $495q Natural Fit LT Omit Grip _________________________________________________________________ $345q Natural Fit Standard Omit Grip ____________________________________________________ $345
Natural Fit Handrims
One Arm Drive
No selection needed with One Arm DriveStandard Handrims
One Arm Drive E0958 __________________________________________________________________________ $1095Available only with 24” Mag wheel. Not available with 14” Rear Seat Height in combination with 24” wheel size or 10” Frame Width. Standard Handrim will be Aluminum Anodized. Axle not quick release.
Drive Handrim Side: q Left q Right
Drive Handrim Type: q Aluminum _________________________________________________ N/Cq Poly Coated __________________________________________ $200
DCN0033.28 Pricing and specifications subject to change without notice Page 4 of 13
Wheel Locks
Wheel Lock Wheel Lock Options
q Push to Lock ________________________________________________________________________________________ Stdq Pull to Lock __________________________________________________________________________________________ N/Cq Omit Wheel Locks _____________________________________________________________________________ N/C
q Extension Handles E0961 ________________________________________________________________ $70Available only with Push to Lock or Pull to Lock Wheel Locks
q Grade Aids E0974 _____________________________________________________________________________ $150Available only with Push to Lock Wheel Locks and Pneumatic and Pneumatic with Airless Insert tires
Select Rear Frame Height in row corresponding to Wheel Size and Tire Profile. 12”-14” Frame Depths not available with 24” wheel size.m Requires curved axle plate q Any axle plate can be used (Curved, Amputee, One Arm Drive)
Wheel Size Tire Profile Rear Frame Height
18”Low m 11 q 11.51 m 12 q 12.51 m 13 q 13.5 m 14 q 14.5 m 15 m 15.5
Full m 11.5 q 121 m 12.5 q 131 m 13.5 q 14 m 14.5 q 15 m 15.5 m 16
20”Low m 11.5 q 121 m 12.5 q 131 m 13.5 q 14 m 14.5 q 15 m 15.5 m 16
Full m 12 q 12.51 m 13 q 13.51 m 14 q 14.5 m 15 q 15.5 m 16 m 16.5
22”Low m 12.5 q 131 m 13.5 q 141 m 14.5 q 15 m 15.5 q 16 m 16.5 m 17
Full m 13 q 13.51 m 14 q 14.51 m 15 q 15.5 m 16 q 16.5 m 17 m 17.5
24”Low m 13.5 q 141 m 14.5 q 151 m 15.5 q 16 m 16.5 q 17 m 17.5 m 18
Full m 14 q 14.51 m 15 q 15.51 m 16 q 16.5 m 17 q 17.5 m 18 m 18.51 Amputee Axle Plate not available with lowest two Rear Frame Height positions
No selection needed with One Arm Drive
m Curved __________________________________________________________________________________________________ N/Cq Amputee _____________________________________________________________________________________________ $175
Not available with Wheelchair Drive Ready Option
Armrest Please select Arm Pad option
Removable Side Guard
q Height Adjustable T-Arm (8.5” - 13.5”) E0973 ________________________________ $265Not available with Frame Depths less than 14”
q Height Adjustable T-Arm Low (7.5” - 11.5”) E0973 ______________________ $265Not available with Frame Depths less than 14”
q Pediatric Height Adjustable T-Arm Desk (6.5” - 10”) E0973 _____ $195q Angle Adjustable Locking Extendable Flip Up E0973 ____________ $265
Not available with Height Adjustable T-Arm Armrests
q Adult Composite Side Guards (14” - 16”) K0108 ________________________ $140q Pediatric Composite Side Guards (10” - 14”) K0108 _________________ $140
Accessories
Anti-Tip
q Rear Anti-Tips E0971 _______________________________________________________________________ $140
Other Accessories
q Tool Kit ___________________________________________________________________________________________________ $45q Removable Underseat Pouch ________________________________________________________ $50
Not available with 10” - 13” Seat Widths
q Pediatric Ki Mobility Backpack ______________________________________________________ $65q Ki Mobility Backpack ________________________________________________________________________ $65q Black Neoprene Impact Guards ____________________________________________________ $85q Cane and Crutch Holder _______________________________________________________________ $195q Canopy with Hardware K0108 New! ________________________________________ $280
See image below
q Tubular Flip Up ____________________________________________________________________________________ N/CNot available with Arm Pads
q Omit Armrests _____________________________________________________________________________________ N/C
Arm PadNot available with Tubular Flip Up Armrests. Full length Arm Pads not available with Pediatric Height Adjustable T-Arms.
Standard Arm Pad __________ N/C q Desk q FullWaterfall Arm Pad ____________ $25 q Desk q Full
Not available with Angle Adjustable Locking Extendable Flip Up Armrest
Foam Grip _________________ N/C q Desk q FullAvailable only with Angle Adjustable Locking Extendable Flip Up Armrest
Armrests
Armrest continued
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Positioning Belt
q 1” Auto Buckle E0978 _______________________________________________________________________ $70q 1” Padded Auto Buckle E0978 _____________________________________________________ $155q 1 1/2” Auto Buckle E0978 ________________________________________________________________ $70q 1 1/2” Padded Auto Buckle E0978 _____________________________________________ $155q 2” Airline Buckle E0978 ___________________________________________________________________ $110
Bodypoint Evoflex - Pelvic Stabilizer E0978 ____________________________________ $183Size: q Small (16-24”) q Medium (19-29”) q Large (25-37”)
Bodypoint Belt Mounting Kit _______________________________________________________________ $105Style: q Bracket q Band Clamp 1”
Spoke Guards
q Clear Spoke Guards K0065 ___________________________________________________________ $115Not available with Mag wheel
q Black Spoke Guards K0065 __________________________________________________________ $115Not available with 18” or 20” wheel sizes or Mag wheel
Designer Spoke Guards K0065 __________________________________________________________ $200Available only with 20” and 22” wheel sizes. Not available with Mag wheel.
Design:
q Blue Monster q Fairy Garden q Havin’ a Hoot
q Robo Fun q Rockin’ Reptiles q Super Puppies
q Tutu Cute q Tuxedo Time
DCN0033.28 Pricing and specifications subject to change without notice Page 5 of 13
Axle
Axles
Axle Position
Rear Wheel Camber: q 0º q 2º q 4ºNo selection needed with One Arm Drive
Center of Gravity: q Rear q Center q Forward
No selection needed with One Arm Drive
q Quick Release ______________________________________________________________________________________ Stdq Quad Quick Release _______________________________________________________________________ $175
Not available with Mag or Spinergy wheels
Canopy Height Above Hardware
14”
Hardware mounts on vertical part of back cane.
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0033.28 Pricing and specifications subject to change without notice Page 6 of 13
Frame Color
Matte FinishGloss Finish
q Army Green __________________________________________________________________________________________ N/Cq Charcoal Gray _____________________________________________________________________________________ N/Cq Emerald Green ____________________________________________________________________________________ N/Cq Iridescent Burgundy __________________________________________________________________________ N/Cq Iridescent Navy ___________________________________________________________________________________ N/Cq Retro Red _____________________________________________________________________________________________ N/Cq Royal Blue ____________________________________________________________________________________________ N/Cq Shadow Black _____________________________________________________________________________________ N/Cq Smooth White _____________________________________________________________________________________ N/C
q Black ______________________________________________________________________________________________________ N/Cq Blue Skies ____________________________________________________________________________________________ N/Cq Bubblegum Pink _________________________________________________________________________________ N/Cq Candy Blue __________________________________________________________________________________________ N/Cq Candy Purple ______________________________________________________________________________________ N/Cq Candy Red ___________________________________________________________________________________________ N/Cq Copper __________________________________________________________________________________________________ N/Cq Granny Smith ______________________________________________________________________________________ N/Cq Metallic Fuchsia New! ____________________________________________________________________ N/Cq Metallic Orange __________________________________________________________________________________ N/Cq Yellow ____________________________________________________________________________________________________ N/C
HydrographicsVisit www.kimobility.com for current Hydrographic options. Note selection below
q $695
DCN0033.28 Pricing and specifications subject to change without notice Page 7 of 13
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Spark Front Frame Height Matrix
3” Caster 4” Caster 5” Caster 6” Caster 7” Caster 8” Caster
FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork FSHSuper Low
Stem Fork
14.5 13.5Std
4”
151 13.51
Std
4”
16 14.5 Std
4”
17 15.5 Std
5”
18 17Std
6”
19 18 std
6”15 14 15.5 14 16.5 15.5 3/4 18 16.5 3/4 18.5 17.5 20 18.5 3/4
15.5 143/4
162 14.52
3/417.5 16 1 1/2 18.5 17 1 1/2 19 17.5
3/420.5 n/a 1 1/2
16 14.5 16.5 15 16 15Std
5”
17 16
Std
6”
19.5 18 19 17.5
std
7”
16 151 1/2
16.52 152
1 1/216.5 15.5 17.5 16.5 19.5 18.5
1 1/219.5 18
16.5 15.5 17 15.5 17 15.53/4
18 17 20 19 20 18.5
15.5 14.5Std
5”
15.5 14.5Std
5”
17.5 16 18 16.5
3/4
18.5 17.5
Std
7”
20.5 19
16 15 16 15 17.5 16.51 1/2
18.5 17 19 18 19.5 18.5
3/416.5 15
3/416.5 15
3/418 17 19 17.5 19.5 18.5 20 19
17 15.5 17 15.5 16.5 15.5
Std
6”
18.5 17.5
1 1/2
20 19 20.5 n/a
17 161 1/2
17 161 1/2
17 16 19 18 19 18
3/4
21 n/a
17.5 16.5 17.5 16.5 17.5 16.5 19.5 18.5 19.5 18.5 20.5 191 1/2
16.5 15.5Std
6”
17 15.5Std
6”
17.5 16
3/4
18 16.5
Std
7”
20 19 21 n/a
17 16 17.5 16 18 16.5 18.5 17 20.5 n/a 8” x 2” caster not available with 6” fork
17.5 163/4
17.5 16.53/4
18.5 17 19 17.5 20 18.5
1 1/218 16.5 18 17 18 17
1 1/2
19.5 18.5 20.5 19
18 171 1/2
18.5 171 1/2
18.5 17.5 18.5 17.5
3/4
21 n/a
18.5 17.5 19 17.5 19 18 19 18
18 17Std
7”
18 16.5
Std
7”
19.5 18.5
18.5 17.5 18.5 17 20 19
19 17.53/4
19 17.5 19.5 18
1 1/219.5 18 18.5 17.5
3/4
20 18.5
19.5 18.51 1/2
19 18 20.5 19
20 19 19.5 18.5 21 n/a
19.5 18
1 1/2
6” x 2” caster not available with 5” fork
20 18.5
20.5 19
1 Front Seat Height not available with 4 x 1” Poly Caster 2 Not available with 4 x 1” Poly, 4 x 1.5” Poly or 4 x 1.5” Soft Roll Aluminum
Seat heights with “FSH” heading available with Standard Front Frame. Seat heights with “Super Low” heading available with Super Low Front Frame. Actual seat height may vary depending upon configuration.
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0033.28 Pricing and specifications subject to change without notice Page 8 of 13
Axiom G, S and P Cushions
Cushions Under 22” WideWidth
14” 15” 16” 17” 18” 19” 20” 21” 22”
Dep
th
14” q15” q q q16” q q q q q q q17” q q q q q q18” q q q q q q q19” q q q20” q q q q q
q Axiom G E2601 __________________________________________________________________________________ $120q Axiom S E2603 __________________________________________________________________________________ $199q Axiom P E2605 __________________________________________________________________________________ $340
q Axiom G E2602 __________________________________________________________________________________ $199q Axiom S E2604 __________________________________________________________________________________ $299q Axiom P E2606 __________________________________________________________________________________ $440
q Axiom SP - Visco E2607 _________________________________________________________________ $410q Axiom SP - Fluid E2607 __________________________________________________________________ $449
q Axiom SP - Visco E2608 _________________________________________________________________ $499q Axiom SP - Fluid E2608 __________________________________________________________________ $549
Width
14” 15” 16” 17” 18” 19” 20” 21” 22”
Dep
th
14” q q q15” q q q q q16” q q q q q q q q17” q q q q q q q q18” q q q q q q q q q19” q q q q q q q q20” q q q q q q q q
Outer Covers
q Axiom G Extra Outer Cover ____________________________________________________________ $70q Axiom S Extra Outer Cover _____________________________________________________________ $80q Axiom P Extra Outer Cover _____________________________________________________________ $90q Axiom SP Extra Visco Outer Cover ____________________________________________ $100q Axiom SP Extra Fluid Outer Cover _____________________________________________ $100
q Axiom SP Extra Visco Inner Cover _____________________________________________ $100q Axiom SP Extra Fluid Inner Cover _______________________________________________ $100
22” Wide Cushions
Axiom SP Cushions
Cushions Under 22” Wide
22” Wide Cushions
Axiom Cushion Accessories
Select size in chart below. Weight capacity: 350 lbs.
Solid Seat Insert ________________________________________________________________________________________ $55
Solid Seat Insert
Inner Covers
Width
14” 15” 16” 17” 18” 19” 20” 21” 22”
Dep
th
14” q15” q q q16” q q q q q q q17” q q q q q q18” q q q q q q q19” q q q20” q q q q qInner Cover Quantity: q 1 q 2
If no selection is made, quantity 1 will be selected
Outer Cover Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Solid Seat Insert Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Axiom SP Cushion Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Axiom G, S or P Cushion Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Select size in chart at right. Weight capacity: 350 lbs.
Select size in chart at right. Weight capacity: 350 lbs.
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0033.28 Pricing and specifications subject to change without notice Page 9 of 13
New!Axiom Back Hardware is included with back. Low Back selections are not available with headrests. Weight capacity: 300 lbs.
Width
12” 14” 16” 18” 20” 22”Retail $555 $555 $555 $555 $555 $791
HCPC E2613 E2613 E2613 E2613 E2613 E2614
Hei
gh
t Lo
w
8” q AXPB1208 q AXPB1408 q AXPB1608 q AXPB1808 q AXPB2008
10” q AXPB1410 q AXPB1610 q AXPB1810 q AXPB2010 q AXPB2210
12” q AXPB1212 q AXPB1412 q AXPB1612 q AXPB1812 q AXPB2012
Mid
14” q AXPB1414 q AXPB1614 q AXPB1814 q AXPB2014 q AXPB2214
16” q AXPB1216 q AXPB1416 q AXPB1616 q AXPB1816 q AXPB2016
18” q AXPB1418 q AXPB1618 q AXPB1818 q AXPB2018 q AXPB2218
Axiom Posterior Back (PB)
Width
12” 14” 16” 18” 20” 22”Retail $636 $636 $636 $636 $636 $862
HCPC E2615 E2615 E2615 E2615 E2615 E2616
Hei
gh
t
Lo
w
8” q AXPL1208 q AXPL1408 q AXPL1608 q AXPL1808 q AXPL2008
10” q AXPL1410 q AXPL1610 q AXPL1810 q AXPL2010 q AXPL2210
12” q AXPL1212 q AXPL1412 q AXPL1612 q AXPL1812 q AXPL2012
Mid
14” q AXPL1414 q AXPL1614 q AXPL1814 q AXPL2014 q AXPL2214
16” q AXPL1216 q AXPL1416 q AXPL1616 q AXPL1816 q AXPL2016
18” q AXPL1418 q AXPL1618 q AXPL1818 q AXPL2018 q AXPL2218
Tall 20” q AXPL1220 q AXPL1420 q AXPL1620 q AXPL1820 q AXPL2020
22” q AXPL1422 q AXPL1622 q AXPL1822 q AXPL2022 q AXPL2222
Axiom Posterior Lateral Back (PL)
Axiom Posterior Back - Low Axiom Posterior Back - Mid
Axiom Posterior Back Measurement Reference
Back Height A B Shell Contour Depth
Hei
gh
t Lo
w
8” 10” 6.5”
2.25”
10” 12” 8.5”
12” 14” 10.5”
Mid
14” 16” 8.5”
16” 18” 9.5”
18” 20” 10.5”
A
4.1
BA
4.1
B
Axiom Posterior Lateral Back Measurement Reference
Back Height A B Shell Contour Depth
Hei
gh
t
Lo
w
8” 10” 6.5”
3.65”
10” 12” 8.5”
12” 14” 10.5”
Mid
14” 16” 8.5”
16” 18” 9.5”
18” 20” 10.5”
Tall 20” 22” 11.5”
22” 24” 12.5”Axiom Posterior Lateral
Back - LowAxiom Posterior Lateral
Back - MidAxiom Posterior Lateral
Back - Tall
A
5.5
B
5.5
AB
A
5.5
B
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0033.28 Pricing and specifications subject to change without notice Page 10 of 13
Width
12” 14” 16” 18” 20” 22”Retail $735 $735 $735 $735 $735 $813
HCPC E2620 E2620 E2620 E2620 E2620 E2621
Hei
gh
t
Lo
w
8” q AXLB1208 q AXLB1408 q AXLB1608 q AXLB1808 q AXLB2008
10” q AXLB1410 q AXLB1610 q AXLB1810 q AXLB2010 q AXLB2210
12” q AXLB1212 q AXLB1412 q AXLB1612 q AXLB1812 q AXLB2012
Mid
14” q AXLB1414 q AXLB1614 q AXLB1814 q AXLB2014 q AXLB2214
16” q AXLB1216 q AXLB1416 q AXLB1616 q AXLB1816 q AXLB2016
18” q AXLB1418 q AXLB1618 q AXLB1818 q AXLB2018 q AXLB2218
Tall 20” q AXLB1220 q AXLB1420 q AXLB1620 q AXLB1820 q AXLB2020
22” q AXLB1422 q AXLB1622 q AXLB1822 q AXLB2022 q AXLB2222
Axiom Lateral Back (LB)
Axiom Back continued Hardware is included with back. Low Back selections are not available with headrests. Weight capacity: 300 lbs.
Axiom Lateral Back Measurement Reference
Back Height A B Shell Contour Depth
Hei
gh
t
Lo
w
8” 10” 6.5”
3.65”
10” 12” 8.5”
12” 14” 10.5”
Mid
14” 16” 8.5”
16” 18” 9.5”
18” 20” 10.5”
Tall 20” 22” 11.5”
22” 24” 12.5”Axiom Lateral
Back - LowAxiom Lateral
Back - MidAxiom Lateral
Back - Tall
A
5.5
B
5.5
AB
A
5.5
B
Axiom Deep Lateral Back (DL)
Width
12” 14” 16” 18” 20” 22”Retail $735 $735 $735 $735 $735 $813
HCPC E2620 E2620 E2620 E2620 E2620 E2621
Hei
gh
t
Mid
14” q AXDL1214 q AXDL1414 q AXDL1614 q AXDL1814 q AXDL2014 q AXDL2214
16” q AXDL1416 q AXDL1616 q AXDL1816 q AXDL2016
18” q AXDL1218 q AXDL1418 q AXDL1618 q AXDL1818 q AXDL2018 q AXDL2218
Tall 20” q AXDL1220 q AXDL1420 q AXDL1620 q AXDL1820 q AXDL2020
22” q AXDL1422 q AXDL1622 q AXDL1822 q AXDL2022 q AXDL2222
Axiom Deep Lateral Back Measurement Reference
Back Height A
B1 Shell Contour Depth12” 14” 16” 18” 20” 22”
Hei
gh
t
Mid
14” 16” 8.25” 8.25” 8.25” 8.25” 8.25” 8.25”
6”
16” 18” 9.25” 9.25” 9.25” 9.25” 9.25” 9.25”
18” 20” 10.25” 10.25” 10.25” 10.25” 10.25” 10.25”
Tall 20” 22” 9.5” 9.75” 10” 10.25” 10.25” 10.5”
22” 24” 10.75” 11” 11.25” 11.5” 11.5” 11.75”1 Measurement based on back width
Axiom Deep Lateral Back - Mid Axiom Deep Lateral Back - Tall
AB
7.75
AB
7.75
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0033.28 Pricing and specifications subject to change without notice Page 11 of 13
Axiom Back Accessories
Headrest and Hardware
HMO400 HMO475-1 TWB480-1
CP450
CP250
CP150
AP250
AP350
AP450
TCP205
TCP105
Choose headrest and hardware combination in chart below. Available only on Mid or Tall
Hardware
Standard Straight Back Mount Hardware with 1” Ball
Multi Axis Removable Hardware with 1” Horizontal Bar
Headrest Hardware with 1” Ball
HMO400 HMO475-1 TWB480-1Description Item Code HCPC Kio Code Retail Kio Code Retail Kio Code Retail
Hea
dre
st P
ad
Comfort Plus Headrest 8” CP450 E0955 q HDR001 $277 q HDR009 $313 q HDR017 $388
Comfort Plus Headrest 10” CP250 E0955 q HDR002 $277 q HDR010 $313 q HDR018 $388
Comfort Plus Headrest 14” CP150 E0955 q HDR003 $277 q HDR011 $313 q HDR019 $388
Small All Positioning Headrest Pad and Ring Only
AP250 E0955 q HDR004 $277 q HDR012 $313 q HDR020 $388
Medium All Positioning Headrest Pad and Ring Only
AP350 E0955 q HDR005 $277 q HDR013 $313 q HDR021 $388
Large All Positioning Headrest Pad and Ring Only
AP450 E0955 q HDR006 $277 q HDR014 $313 q HDR022 $388
Tri-Comfort Plus Headrest 14” TCP205 E0955 q HDR007 $288 q HDR015 $324 q HDR023 $399
Tri-Comfort Plus Headrest 19” TCP105 E0955 q HDR008 $288 q HDR016 $324 q HDR024 $399
For use with other manufacturer headrests
Description Item Code HCPC Retail
q Universal Mounting Plate UMP K0108 $40
Universal Mounting Hardware
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0033.28 Pricing and specifications subject to change without notice Page 12 of 13
Axiom Back Accessories continued
Available only with Axiom Lateral Back and Axiom Deep Lateral back
Description Item Code HCPC Retail
q Lumbar Pad 12” L12 K0108 $48
q Lumbar Pad 14” L14 K0108 $48
q Lumbar Pad 16” L16 K0108 $48
q Lumbar Pad 18” L18 K0108 $48
q Lumbar Pad 20” L20 K0108 $48
q Lumbar Pad 22” L22 K0108 $48
Lumbar Pads
Description Item Code HCPC Retail
q Privacy Flap 12” PF12 K0108 $45
q Privacy Flap 14” PF14 K0108 $45
q Privacy Flap 16” PF16 K0108 $45
q Privacy Flap 18” PF18 K0108 $45
q Privacy Flap 20” PF20 K0108 $45
q Privacy Flap 22” PF22 K0108 $45
Privacy Flap
Lateral SupportSold in pairs
Description Item Code HCPC Retail
Laterals for Posterior Back
q 3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF3x4P E0956 $305
q 4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF4x5P E0956 $305
q3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back
LS3x4P E0956, E1028 $650
q4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back
LS4x5P E0956, E1028 $650
Laterals for Posterior Lateral Back and Lateral Back
q3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral and Axiom Lateral Backs
LF3x4L E0956 $305
q4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral and Axiom Lateral Backs
LF4x5L E0956 $305
q3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral and Axiom Lateral Backs
LS3x4L E0956, E1028 $650
q4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral and Axiom Lateral Backs
LS4x5L E0956, E1028 $650
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0033.28 Pricing and specifications subject to change without notice Page 13 of 13
Axiom Back Accessories continued
Description Item Code HCPC Retail
q Small Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60153T E0960 $144
q Medium Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60154T E0960 $144
q Large Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60155T E0960 $144
q Small Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60110T E0960 $113
q Medium Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60111T E0960 $113
q Large Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60112T E0960 $113
q Small Dynamic Therafit Comfortfit Full Vest 30589T E0960 $167
q Medum Dynamic Therafit Comfortfit Full Vest 30590T E0960 $167
q Large Dynamic Therafit Comfortfit Full Vest 30591T E0960 $167
q XLarge Dynamic Therafit Comfortfit Full Vest 30592T E0960 $167
q XXLarge Dynamic Therafit Comfortfit Full Vest 30593T E0960 $167
q Small Dynamic Therafit Comfortfit Trim Vest 30618T E0960 $169
q Medum Dynamic Therafit Comfortfit Trim Vest 30619T E0960 $169
q Large Dynamic Therafit Comfortfit Trim Vest 30620T E0960 $169
q XLarge Dynamic Therafit Comfortfit Trim Vest 30621T E0960 $169
q XXLarge Dynamic Therafit Comfortfit Trim Vest 30622T E0960 $169
Therafin Posture Support
Description Item Code HCPC Retail
q Modification for 4 Point Harness AXM4PT K0108 N/C
q Modification for 2 Point Chest Strap AXM2PT K0108 N/C
q Modification for Shoulder GuidesIncludes shoulder guides
AXMSG K0108 $50
Axiom Back Modifications
Gloss Finish Item Code Retail
q Black AXMBLK N/C
q Blue Skies AXMSKY N/C
q Bubblegum Pink AXMPNK N/C
q Candy Blue AXMCBL N/C
q Candy Purple AXMPUR N/C
q Candy Red AXMRED N/C
q Copper AXMCOP N/C
q Granny Smith AXMGSM N/C
q Metallic Fuchsia AXMMTF N/C
q Metallic Orange AXMMOR N/C
q Yellow AXMYLW N/C
Painted Back Shell Modification
Matte Finish Item Code Retail
q Army Green AXMAGM N/C
q Charcoal Gray AXMCGM N/C
q Emerald Green AXMEGM N/C
q Iridescent Burgundy AXMIBM N/C
q Iridescent Navy AXMINM N/C
q Retro Red AXMRRM N/C
q Royal Blue AXMRBM N/C
q Smooth White AXMSWM N/C
If no selection is made, standard Shadow Black will be used with no additional lead time
Axiom Back Modifications Extended lead times will apply for all modifications
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