qqqqqqqqq q qqqqqqqqq q qqqqqqqqq q ... - Ki Mobility · Not available on Superlight wheel or 25”...
13
Phone (800) 981-1540 | Fax (715) 254-0996 [email protected] | www.kimobility.com 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 Seat Width / Seat Depth Select box corresponding to desired Seat Width and Depth. See references A and B on page 7. Seat Width 12” 13” 14” 15” 16” 17” 18” 19” 20” Price HCPCS N/C N/C N/C N/C N/C N/C N/C N/C $500 E2201 Seat Depth 14” N/C qq q q q q q qq 15” N/C qq q q q q q qq 16” N/C qq q q q q q qq 17” N/C qq q q q q q qq 18” N/C qq q q q q q qq 19” N/C qq q q q q q qq 20” $500 E2203 qq q q q q q qq Transit Option Sling Position In Performance Position (0”), sling is at front of frame. The 1” or 2” sling position extends the frame in front of the sling by that amount. See reference C on page 7. q 0” (Performance) ________________________________________________________________________________ N/C q 1” _____________________________________________________________________________________________________________ N/C q 2” (Classic) ___________________________________________________________________________________________ N/C Backrest Adjustable Depth Adds the capability to grow seat in depth q No Rear Adjustment _________________________________________________________________________ N/C q 1/2” _________________________________________________________________________________________________________ N/C q 1” _____________________________________________________________________________________________________________ $85 q 2” ___________________________________________________________________________________________________________ $165 Front Frame Bend Angle between front seat tube and ground. See reference D on page 7. q 90º ________________________________________________________________________________________________________ $150 q 85º __________________________________________________________________________________________________________ N/C q 80º __________________________________________________________________________________________________________ N/C q 75º __________________________________________________________________________________________________________ N/C q 70º __________________________________________________________________________________________________________ N/C Push Handle q Omit Push Handle _____________________________________________________________________________ N/C q Standard Push Handle _____________________________________________________________________ $95 q Low Profile Push Handle _______________________________________________________________ $135 2” shorter than standard push handles q Bolt-On Push Handle ______________________________________________________________________ $175 Handles will be 1” - 2” above back height q Fold Down Push Handle ________________________________________________________________ $100 Stroller Handle Stroller Handles are removable and height adjustable q Single Stroller Handle _____________________________________________________________________ $165 q Double Stroller Handle ___________________________________________________________________ $330 Not available with Push Handles Back Post / Height Range / Back Height Cannot be retrofitted q Transit System __________________________________________________________________________________ $320 Select Back Height in row corresponding to desired Back Post and Height Range. Back Post Price Height Range Back Height Height Adjustable N/C Short q 11 2 q 12 q 13 q 14 Medium q 13 q 14 q 15 q 16 q 17 Tall q 17 q 18 q 19 q 20 Fixed Height 1 N/C q 9 2 q 10 2 q 11 2 q 12 q 13 q 14 q 15 q 16 q 17 q 18 1 Not available with back upholstery 2 Not available with Fold Down Push Handle DCN0025.32 Pricing and specifications subject to change without notice Page 1 of 7 Rogue K0005, E1235 ____________________________________________________________________ $2495 Rogue Standard Frame. 275 lb weight capacity. This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Seat Pan q Solid Seat Pan E2231 ______________________________________________________________________ $265 Effective 02/17/2020 Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________
Transcript of qqqqqqqqq q qqqqqqqqq q qqqqqqqqq q ... - Ki Mobility · Not available on Superlight wheel or 25”...
Phone (800) 981-1540 | Fax (715) [email protected] | www.kimobility.com
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
Seat Width / Seat DepthSelect box corresponding to desired Seat Width and Depth.See references A and B on page 7.
Seat Width
12” 13” 14” 15” 16” 17” 18” 19” 20”
PriceHCPCS
N/C N/C N/C N/C N/C N/C N/C N/C$500E2201
Sea
t D
epth
14” N/C q q q q q q q q q15” N/C q q q q q q q q q16” N/C q q q q q q q q q17” N/C q q q q q q q q q18” N/C q q q q q q q q q19” N/C q q q q q q q q q20” $500
E2203 q q q q q q q q q
Transit Option
Sling PositionIn Performance Position (0”), sling is at front of frame. The 1” or 2” sling position extends the frame in front of the sling by that amount. See reference C on page 7.
q 0” (Performance) ________________________________________________________________________________ N/Cq 1” _____________________________________________________________________________________________________________ N/Cq 2” (Classic) ___________________________________________________________________________________________ N/C
Backrest
Adjustable DepthAdds the capability to grow seat in depth
q No Rear Adjustment _________________________________________________________________________ N/Cq 1/2” _________________________________________________________________________________________________________ N/Cq 1” _____________________________________________________________________________________________________________ $85q 2” ___________________________________________________________________________________________________________ $165
Front Frame BendAngle between front seat tube and ground. See reference D on page 7.
q 90º ________________________________________________________________________________________________________ $150q 85º __________________________________________________________________________________________________________ N/Cq 80º __________________________________________________________________________________________________________ N/Cq 75º __________________________________________________________________________________________________________ N/Cq 70º __________________________________________________________________________________________________________ N/C
Push Handle
q Omit Push Handle _____________________________________________________________________________ N/Cq Standard Push Handle _____________________________________________________________________ $95q Low Profile Push Handle _______________________________________________________________ $135
2” shorter than standard push handles
q Bolt-On Push Handle ______________________________________________________________________ $175Handles will be 1” - 2” above back height
q Fold Down Push Handle ________________________________________________________________ $100
Stroller HandleStroller Handles are removable and height adjustable
q Single Stroller Handle _____________________________________________________________________ $165q Double Stroller Handle ___________________________________________________________________ $330
Not available with Push Handles
Back Post / Height Range / Back Height
Cannot be retrofitted
q Transit System __________________________________________________________________________________ $320
Select Back Height in row corresponding to desired Back Post and Height Range.
BackPost
Price Height Range
Back Height
Height Adjustable
N/C
Short q 112 q 12 q 13 q 14
Medium q 13 q 14 q 15 q 16 q 17
Tall q 17 q 18 q 19 q 20
FixedHeight 1
N/Cq 92 q 102 q 112 q 12 q 13
q 14 q 15 q 16 q 17 q 181 Not available with back upholstery2 Not available with Fold Down Push Handle
DCN0025.32 Pricing and specifications subject to change without notice Page 1 of 7
Rogue K0005, E1235 ____________________________________________________________________ $2495Rogue Standard Frame. 275 lb weight capacity.
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows.
Seat Pan
q Solid Seat Pan E2231 ______________________________________________________________________ $265
Effective 02/17/2020
Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________
Rigidizer Bar
q Adjustable Height Rigidizer Bar _____________________________________________________ $75
Seat Back AngleStandard is 90º (perpendicular to floor). Minus (-º) closes back angle. Plus (+º) opens back angle.
q Standard q +3º q +6º q +9ºq -3º q -6º q -9º q -12º
Backrest continued
Military Patch
Back Upholstery
US Military Service Patch _______________________________________________________________________ $90 q Army q Navy q Marines q Air Force q Coast Guard
q US Purple Heart Patch _____________________________________________________________________ $90
Purple Heart with Military Service Patch Combo __________________________ $145 q Army q Navy q Marines q Air Force q Coast Guard
Front Seat Height and Casters
Caster Type
Caster Size / Footrest Taper / Front Seat Height
Fork Options
q Standard Fork ______________________________________________________________________________________ Stdq Single Sided Fork _____________________________________________________________________________ $150q Frog Legs Ultra-Sport Fork - Black E1015 ________________________________ $425
Not included in Colored Anodizing Package
End User Weight Required: ____________ lbsq Frog Legs PHASE 2 Carbon Fork ______________________________________________ $425
Lightweight shock absorbing fork. Not included in Colored Anodizing Package.
Select Front Seat Height in row corresponding to Footrest Taper and Caster Size. 6” casters not available with 85º and 90º Front Frame Bend.
Footrest Taper indicates bend of front frame creating footrest width. Taper is measured from outside of seat frame to outside of front tube.2” Taper not available with 75º Front Frame Bend. Taper is not available with 70º Front Frame Bend. See reference E on page 7.
Front Seat Height is measured from floor to top of seat tube at front of seat sling. Adjustable up or down by 1/2”. See reference F on page 7.
Footrest Taper
Caster Size
Front Seat Height
Straight
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 q 19 q 19.5 q 20 q 20.5
4” 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 q 19 q 19.5 q 20 q 20.5
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 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
1” Taper
3” q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
4” q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
5” q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
6” q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
2” Taper
3” q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
4” q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
5” q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
6” q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0025.32 Pricing and specifications subject to change without notice Page 2 of 7
q .75” Rollerblade __________________________________________________________________________________ N/CAvailable only with 3” and 4” Caster Sizes
q .75” Lighted Rollerblade __________________________________________________________________ $70Available only with 3” and 4” 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 _______________________________________________________________________________________ $80Available only with 6” Caster Size
q 1.5” Poly _______________________________________________________________________________________________ $50Not available with 3” Caster Size
q 1.5” Soft Roll Aluminum _________________________________________________________________ $175
Available only with Height Adjustable Back Posts. If selecting both upholstery and Axiom Back, the upholstery will be installed.
Padded Velcro Adjustable q Standard Cover ______________________________ Std q Air Mesh Breathable Cover _____________________ $75
Tension Adjustable E2611
q Standard Cover _____________________________ $315 q Air Mesh Breathable Cover ____________________ $390
q Omit Back Upholstery ___________________________________________________________________ - $10
Footrest
Seat to Footrest LengthFootplate
q Tubular “Open” Footplate _________________________________________________________________ Stdq Tubular Footplate with ABS Cover _______________________________________________ $30
Not available w/footrest widths greater than 15.5”. See Reference G on page 7.
q Aluminum Angle Adjustable K0040 _______________________________________________ $95q Aluminum Angle Adjustable with Riser K0040, K0037 _____________ $165q High Mount Aluminum Angle Adjustable K0040, K0037 _________ $165q Angle Adjustable Flip Under K0040, K0037 _________________________________ $185
Not available with footrest widths less than 9.5”. See Reference G on page 7.
q High Mount Angle Adjustable Flip Under K0040, K0037 _________ $270Not available w/footrest widths greater than 15.5”. See Reference G on page 7.
Measured from front edge of seat sling to top, rear of footrest. Footrest length at least 2.5” shorter than Front Seat Height recommended. See reference H on page 7.
q 8” q 8.5” q 9” q 9.5” q 10” q 10.5”
q 11” q 11.5” q 12” q 12.5” q 13” 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” q 19” q 19.5”
Rear Seat Height and Wheels
Wheel Size / Rear Seat Height
Rear Wheel Type
q MAXX Performance Spoke _____________________________________________________________ N/Cq Mag ________________________________________________________________________________________________________ N/C
Not available in 25” or 26” wheel sizes
q Superlight Spoke _____________________________________________________________________________ $315Available only in 24” and 25” wheel sizes. 25” wheel size available only with Superlight and Plastic Coated Handrims.
Spinergy Spox _________________________________________________________________________________________ $835Not available in 20” wheel size
Color: q Black q Red q White q Blue q Yellow
Handrim: q Short Tab $25 q Long TabAvailable only with Aluminum Anodized and Plastic Coated Handrims
Spinergy LX ___________________________________________________________________________________________ $1040Not available in 20” wheel size
Color: q Black q Red q White q Blue q Yellow
q Pink q Green q Orange q Purple
Handrim: q Short Tab $25 q Long TabAvailable only with Aluminum Anodized and Plastic Coated Handrims
Select Rear Seat Height in row corresponding to desired Wheel Size. For proper setup, selection is required when omitting rear wheels.Measured from floor to top of seat tube at front of back post. Rear Seat Height is custom to needs. See reference I on page 7.
Wheel Size
Rear Seat Height
20” q12.51 q 13 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 q 19 q 19.5 q 20
22” q13.51 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 q 19 q 19.5 q 20
24” q14.51 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
25” q 151 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
26” q15.51 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 201 Available only with Low Profile tires
Rear Tire Type
q Street Pneumatic 1 3/8” E2211, E2212 ___________________________________________ StdNot available on 25” wheel size
q Full Poly 1 3/8” E2218 _______________________________________________________________________ N/CNot available on Superlight wheel or 25” or 26” wheel sizes
q Pneumatic with Airless Insert 1 3/8” E2211, E2213 ____________________ $80Not available on Superlight wheel or 25” wheel size
q Schwalbe HS-127 1 3/8” E2211, E2212 ______________________________________ $125Available only on 24” wheel size. Not available on Mag wheel.
q Euro Trek Knobby 1 3/8” E2211, E2212 _________________________________________ $95Available only on 24” wheel size
q Mountain 2” Black E2211, E2212 _____________________________________________________ $95Available only on 22”, 24” and 25” MAXX Performance and Spinergy wheels
q Low Poly 1” E2218 _____________________________________________________________________________ $75Not available on Superlight wheel, 25” or 26” wheel sizes
q Sentinel Solid Tire 1” E2218 ____________________________________________________________ $95Not available on Superlight wheel or 20” and 22” Mag wheels
q High Pressure 1” E2211, E2212 ________________________________________________________ $95Not available on Mag wheel
q Schwalbe One 1” E2211, E2212 ____________________________________________________ $125Available only on 24” and 25” wheel sizes. Not available on Mag wheel.
q Schwalbe Marathon Plus Evolution 1” E2211, E2212 ______________ $135Not available on Mag wheel, 20” or 22” wheel sizes
Full Profile
Low Profile
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
q Footrest Protector _____________________________________________________________________________ N/CNot available with Angle Adjustable Flip Under, High Mount Angle Adjustable Flip Under or High Mount Aluminum Angle Adjustable Footplates
Footrest Protector
One Arm Drive E0958 __________________________________________________________________________ $1495Available only with Mag wheel. Axle not quick release. Standard Handrim will be Aluminum Anodized.
Drive Handrim Side: q Left q Right
Drive Handrim Type: q Aluminum _______________________________________ N/C q Poly Coated _________________________________ $200
One Arm Drive
DCN0025.32 Pricing and specifications subject to change without notice Page 3 of 7
Handrim
Axle
q Quick Release ______________________________________________________________________________________ Stdq Quad Quick Release _______________________________________________________________________ $185
Not available with Mag or Spinergy wheels
Rear Wheel SpacingMeasured from outside of back to inside of rear tire. Adjustable out 1/2” from setting. 1.5” minimum Rear Wheel Spacing with Height Adjustable Armrests. 1” minimum Rear Wheel Spacing with 0º Rear Wheel Camber. 1.25” minimum Rear Wheel Spacing in combination with One Arm Drive and 12” Seat Width. See reference K on page 7. No selection needed with Wheelchair Drive Ready options.
q .75” q 1” q 1.25” q 1.5” q 1.75”
Rear Wheel Camber
Center of Gravity Preset
Handrim Option
q 3M Micro Grip _____________________________________________________________________________________ $65Not available on Plastic Coated or Projection Handrims
Rear Seat Height and Wheels continued
Measured from front of back post to center of rear axle. 0” indicates axle will be directly under back post. See reference J on page 7.
Wheel Locks
Wheel Lock Wheel Lock Options
q Push to Lock ________________________________________________________________________________________ Stdq Push to Lock Flush Mount ______________________________________________________________ N/Cq Pull to Lock __________________________________________________________________________________________ N/Cq Under Seat Scissor Lock _________________________________________________________________ $35q Low Profile Scissor Lock _________________________________________________________________ $65
Not available with Low Poly, Full Poly or Sentinel Solid tires
q Short Thro Scissor Lock ________________________________________________________________ $125q Omit Wheel Locks _____________________________________________________________________________ N/C
Amputee Positions
q -1.5” q -1.25” q -1” q -.75”
q -.5” q -.25” q 0” q .25”
q .5” q .75” q 1” q 1.25”
q 1.5” q 1.75” q 2” q 2.25”
q 2.5” q 2.75” q 3” q 3.25”
q 3.5” q 3.75” q 4” q 4.25”
Standard Positions
q Aluminum Anodized ___________________________________________________________________________ Stdq Superlight Aluminum Anodized _____________________________________________________ $50
Available only on 24” and 25” wheel sizes. Available only on MAXX Performance, Superlight or Spinergy wheels.
q Plastic Coated ___________________________________________________________________________________ $100q Projection (8 Vertical Projections) ________________________________________________ $315
Available only with full profile tires in combination with 22”-26” MAXX Performance or 24” Mag wheel
q Spinergy Flex Rim ____________________________________________________________________________ $650Available only on 24” and 25” Spinergy LX Wheels
q Omit Handrim ______________________________________________________________________________________ N/C
Not available on 20” wheel size or 22” Mag wheel. Not recommended with Mag wheel.
q Natural Fit LT Regular Grip ____________________________________________________________ $465q Natural Fit Standard Regular Grip _______________________________________________ $445q Natural Fit LT Super Grip _______________________________________________________________ $515q Natural Fit Standard Super Grip __________________________________________________ $495q Natural Fit LT Omit Grip _________________________________________________________________ $395q Natural Fit Standard Omit Grip ____________________________________________________ $375
Natural Fit Handrims
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0025.32 Pricing and specifications subject to change without notice Page 4 of 7
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 or Pneumatic with Airless Insert tires
Wheelchair Drive ReadyChair will ship from Ki Mobility with adaption kit installed for selected Alber system. Order system separately from Alber USA. Select Rear Seat Height (full profile selections only) in drive wheel size on Rear Seat Height chart (page 3). Requires Rear Anti-Tips. Not available with Spinergy wheels.
q e-motion Ready __________________________________________________________________________________ N/Cq twion Ready _________________________________________________________________________________________ N/C
Camber Selection: q 0º q 3º
No selection needed with One Arm Drive Standard Handrims
No selection needed with One Arm Drive
q 0º q 2º q 4º q 6º q 8º
Accessories
Anti-Tip
q Rear Anti-Tips E0971 _______________________________________________________________________ $145
Positioning Belt
q 1 1/2” Auto Buckle E0978 ________________________________________________________________ $70q 1 1/2” Padded Auto Buckle E0978 _____________________________________________ $155q 1” Auto Buckle E0978 _______________________________________________________________________ $70q 1” Padded Auto Buckle E0978 _____________________________________________________ $155q 2” Airline Buckle E0978 ___________________________________________________________________ $110
Bodypoint Evoflex - Pelvic Stabilizer E0978 ____________________________________ $183 Size: q Small (16-24”) q Medium (19-29”) q Large (25-37”)
Other Accessories
q Tool Kit ___________________________________________________________________________________________________ $45q Removable Underseat Pouch ________________________________________________________ $50q Ki Mobility Backpack ________________________________________________________________________ $65q Luggage Carrier _________________________________________________________________________________ $85q Black Neoprene Impact Guards ____________________________________________________ $90q Under Chair Carrier and Removable Bag ___________________________________ $85
Not available with Seat Widths less than 14”
q Clear Spoke Guards K0065 ___________________________________________________________ $115Not available with Mag wheel
q Black Spoke Guards K0065 __________________________________________________________ $115Not available with 20” wheel size or Mag wheel
q Cane and Crutch Holder _______________________________________________________________ $195
Calf Strap
q Velcro Adjustable K0038 ___________________________________________________________________ $40q Padded Velcro Adjustable K0038 __________________________________________________ $68q Bodypoint Padded AeroMesh K0038 _________________________________________ $102
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Side Guards
Fabric Side GuardNot available when omitting Back Upholstery
q Fabric Side Guards K0108 _______________________________________________________________ $95
Belt Mounting Kit
q Ki Mobility Belt Mounting Clamp ___________________________________________________ $35q Bodypoint Belt Mounting Bracket Kit ________________________________________ $105
q Composite Side Guards K0108 ____________________________________________________ $145
Aluminum Straight K0108 New! q Black Matte _________________________________ $195q Match Frame Color __________________________ $245
Not available with Hydrographics
Aluminum Adjustable Fender with Foam Pad K0108Not available with Adjustable Depth greater than 1/2”
q Black Matte _________________________________ $275 q Match Frame Color __________________________ $325
Not available with Hydrographics
q Carbon Fiber Adjustable Fender K0108 _____________________________________ $485Not available with Adjustable Depth greater than 1/2”
Direct Mount
q Composite Side Guards K0108 ____________________________________________________ $175
Aluminum Straight K0108 New! q Black Matte _________________________________ $225 q Match Frame Color __________________________ $275
Not available with Hydrographics
Aluminum Adjustable Fender with Foam Pad K0108
q Black Matte _________________________________ $305 q Match Frame Color __________________________ $355
Not available with Hydrographics
q Carbon Fiber Adjustable Fender K0108 _____________________________________ $515
Clamp-On Mount
DCN0025.32 Pricing and specifications subject to change without notice Page 5 of 7
Armrests
Armrest Please select Arm Pad option
q Height Adjustable T-Arm (8.5” - 13.5”) E0973 ________________________________ $340q Height Adjustable T-Arm Low (7.5” - 11.5”) E0973 ______________________ $340
q Swing Away (8.5” - 12.5”) E0973 _______________________________________________________ $210Not available with Arm Pads
q Swing Away with Side Guard (8.5” - 12.5”) E0973 _______________________ $285Includes direct mount receiver. Not available with Arm Pads.
q Omit Armrests _____________________________________________________________________________________ N/CArm Pad
Armrest continued
Not available with Swing Away Armrests
q Desk q Full
Not available with T-Arms or Swing Away with Side Guard Armrests
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0025.32 Pricing and specifications subject to change without notice Page 6 of 7
Color
HydrographicsVisit www.kimobility.com for current Hydrographic options. Note selection below
q _________________________________________________ $595Not available with Transit Option
Colored Anodizing Package
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 __________________________________________________________________________________ N/Cq Metallic Orange __________________________________________________________________________________ N/Cq Silver ______________________________________________________________________________________________________ N/Cq Yellow ____________________________________________________________________________________________________ N/C
q Charcoal Gray _____________________________________________________________________________________ N/Cq Emerald Green ____________________________________________________________________________________ N/Cq Iridescent Burgundy __________________________________________________________________________ N/C q Iridescent Navy ___________________________________________________________________________________ N/Cq Military Green ______________________________________________________________________________________ N/Cq Retro Red _____________________________________________________________________________________________ N/Cq Royal Blue ____________________________________________________________________________________________ N/Cq Shadow Black _____________________________________________________________________________________ N/Cq Smooth White _____________________________________________________________________________________ N/C
Matte Frame FinishGloss Frame Finish
Select desired color. If no selection is made, black will be used.
Option Back Plates 2 Camber Tube 3 Towers CG Clamps 3,5 Side GuardReceivers
RP TuningHousing
Front Caster 4
ForksRetail $25 $25 $25 $25 $25 $25 $25
Co
lor
Black 1 q q q q q q qBlue q q q q q q qBright Green q q q q q q qGold q q q q q q qOrange q q q q q q qPewter q q q q q q qPink q q q q q q qPurple q q q q q q qRed q q q q q q q
1 Black is no charge2 Not available with Transit Option3 Not available with Wheelchair Drive Ready4 Available only with Standard or Single Sided5 Not available with negative Center of Gravity
References A. Seat Width See Diagram 1
Measured from outside of frame tube on one side to outside of frame tube on other side.
B. Seat Depth See Diagram 3
Measured from front of back posts to front edge of seat sling. Seat sling starts at beginning of bend at front of frame.
C. Sling Position See Diagram 2
In Performance Position (0”), sling is at front of frame to keep chair shorter and more maneuverable. The 1” or 2” seat sling position extends the frame in front of the sling by that amount. Adding more frame can improve stability and provide support to aid in transfers.
D. Front Frame Bend See Diagram 3
Angle between front seat tube and ground.
Seat Width Straight 1” Taper 2” TaperOutside
Measurement2” Narrower than
Seat Width4” Narrower than
Seat Width6” Narrower than
Seat Width
12” 9.5” 7.5”
13” 10.5” 8.5”
14” 11.5” 9.5”
15” 12.5” 10.5”
16” 13.5” 11.5” 9.5”
17” 14.5” 12.5” 10.5”
18” 15.5” 13.5” 11.5”
19” 16.5” 14.5” 12.5”
20” 17.5” 15.5” 13.5”
F. Front Seat Height See Diagram 1
Measured from floor to top of seat tube at front of seat sling.
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
C
Diagram 2
Diagram 1
A
GF
K
E
G. Footrest Width See Diagram 1
Measured from inside of front tube to inside of front tube on other side. Footrest width is listed below for each seat width and taper.
E. Footrest Taper See Diagram 1
Indicates bend of front frame creating footrest. Taper is measured from outside of seat frame to outside of front tube.
H. Seat to Footrest Length See Diagram 3
Measured from front edge of seat sling to top rear of footrest. Footrest length of at least 2.5” shorter than front seat height recommended.
I. Rear Seat Height See Diagram 3
Measured from floor to top of seat tube at front of back post. Rear seat height is custom to needs.
J. Center of Gravity Preset See Diagram 3
Measured from front of back post to center of rear axle. 0” indicates axle will be directly under back post.
K. Rear Wheel Spacing See Diagram 1
Measured from outside of seat back to inside of rear tire. Adjustable out .5” from setting.
DCN0025.32 Pricing and specifications subject to change without notice Page 7 of 7
Diagram 3
B
H
JI
D
DCN0537.0 Pricing and specifications subject to change without notice Page 1 of 1
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 q q18” q q q q q q q q19” q q q q q q q20” q q q q q q q21” q q q q q22” q q q q q
Width
14” 15” 16” 17” 18” 19” 20” 21” 22”D
epth
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 q q20” q q q q q q q q q21” q q q q q q q q22” q q q q q q q q
Width
14” 15” 16” 17” 18” 19” 20” 21” 22”
Dep
th
14” q q q15” 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 q q20” q q q q q q q q q21” q q q q q q q q22” q q q q q q q q
q Axiom G E2601 __________________________________________________________________________________ $120q Axiom S E2603 __________________________________________________________________________________ $210q Axiom P E2605 __________________________________________________________________________________ $355
q Axiom G E2602 __________________________________________________________________________________ $199q Axiom S E2604 __________________________________________________________________________________ $315q Axiom P E2606 __________________________________________________________________________________ $460
q Axiom SP - Visco E2607 _________________________________________________________________ $430q Axiom SP - Fluid E2607 __________________________________________________________________ $470
q Axiom SP - Visco E2608 _________________________________________________________________ $525q Axiom SP - Fluid E2608 __________________________________________________________________ $575
q Axiom G Extra Outer Cover ____________________________________________________________ $75q Axiom S Extra Outer Cover _____________________________________________________________ $85q Axiom P Extra Outer Cover _____________________________________________________________ $95q Axiom SP Extra Visco Outer Cover ____________________________________________ $105q Axiom SP Extra Fluid Outer Cover _____________________________________________ $105
q Axiom SP Extra Visco Inner Cover _____________________________________________ $105q Axiom SP Extra Fluid Inner Cover _______________________________________________ $105
Select size in chart below. Weight capacity: 350 lbs.
Solid Seat Insert ________________________________________________________________________________________ $60
Inner Cover Quantity: q 1 q 2If 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
Axiom G, S and P Cushions
Cushions Under 22” Wide
Outer Covers
22” Wide Cushions
Axiom SP Cushions
Cushions Under 22” Wide
22” Wide Cushions
Axiom Cushion Accessories
Solid Seat Insert
Inner Covers
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
DCN0538.0 Pricing and specifications subject to change without notice Page 1 of 5
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Axiom Back Select back that is the same or up to 2” narrower than the width of the frame. Hardware is included with back. Low Back selections are not available with headrests, modifications, or posture supports. 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
DCN0538.0 Pricing and specifications subject to change without notice Page 2 of 5
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 Select back that is the same or up to 2” narrower than the width of the frame. Hardware is included with back. Low Back selections are not available with headrests, modifications, or posture supports. 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
Description Item Code HCPC Retail (Each)
q Headrest Flip Down MountOnly available with HEDHMD401/HEDHMD417
HDR100 E1028 $170
q Universal Mounting PlateFor use with other manufacturer headrests
UMP K0108 $40
DCN0538.0 Pricing and specifications subject to change without notice Page 3 of 5
Axiom Back Accessories
Headrest and HardwareChoose headrest and hardware combination in chart below. Not available with Low Backs.
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
HEDHDW101/HEDHDW117 HEDHDW201/HEDHDW217 HEDHDW401/HEDHDW417
HEDPAD408
HEDPAD410
HEDPAD414
HEDPAD201
HEDPAD202
HEDPAD203
HEDPAD502
HEDPAD503
Hardware
Standard Straight Back Mount Hardware with Ball
Multi Axis Removable Hardware with Horizontal Bar
Headrest Hardware with Ball
HEDHDW101 / HEDHDW117 HEDHDW201 / HEDHDW217 HEDHDW401 / HEDHDW417
Description Item Code HCPC Kio Code Retail Kio Code Retail Kio Code Retail
Hea
dre
st P
ad
Comfort Plus Headrest 8” HEDPAD408 E0955E1028 q HDR001 $277 q HDR009 $313 q HDR017 $388
Comfort Plus Headrest 10” HEDPAD410 E0955E1028 q HDR002 $277 q HDR010 $313 q HDR018 $388
Comfort Plus Headrest 14” HEDPAD414 E0955E1028 q HDR003 $277 q HDR011 $313 q HDR019 $388
Small All Positioning Headrest Pad and Ring Only HEDPAD201 E0955
E1028 q HDR004 $277 q HDR012 $313 q HDR020 $388
Medium All Positioning Headrest Pad and Ring Only
HEDPAD202 E0955E1028 q HDR005 $277 q HDR013 $313 q HDR021 $388
Large All Positioning Headrest Pad and Ring Only HEDPAD203 E0955
E1028 q HDR006 $277 q HDR014 $313 q HDR022 $388
Tri-Comfort Plus Headrest 14”
HEDPAD502 E0955E1028 q HDR007 $288 q HDR015 $324 q HDR023 $399
Tri-Comfort Plus Headrest 19”
HEDPAD503 E0955E1028 q HDR008 $288 q HDR016 $324 q HDR024 $399
Headrest Hardware Options
DCN0538.0 Pricing and specifications subject to change without notice Page 4 of 5
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
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Lateral Support
Laterals for Posterior BackPair Left Right Description Item Code HCPC Pair Each
q q q 3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF3x4P E0956 $305 $153
q q q 4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF4x5P E0956 $305 $153
q q q 3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back LS3x4P E0956, E1028 $650 $325
q q q 4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back LS4x5P E0956, E1028 $650 $325Laterals for Posterior Lateral BackPair Left Right Description Item Code HCPC Pair Each
q q q 3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral Back LF3x4L E0956 $305 $153
q q q 4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral Back LF4x5L E0956 $305 $153
q q q3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral Back
LS3x4L E0956, E1028 $650 $325
q q q4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral Back
LS4x5L E0956, E1028 $650 $325
DCN0538.0 Pricing and specifications subject to change without notice Page 5 of 5
Axiom Back Accessories continued
Selection of a modification from the Axiom Back Modifications section required in order to mount posture supports. Not available with Low Backs.
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
Choose modification to add holes to the back shell in order to mount posture supports. Not available with Low Backs.
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 Silver AXMSIL N/C
q Teal AXMTEA N/C
q Yellow AXMYLW N/C
Painted Back Shell ModificationIf 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
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Matte Finish Item Code Retail
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 Military Green AXMAGM N/C
q Retro Red AXMRRM N/C
q Royal Blue AXMRBM N/C
q Smooth White AXMSWM N/C
