Quantum Q6 Edge HD Order Form with TRU-Balance 3 …

of 16INFINFB4241/RevC/03AUG2021

Q6 Edge® HD Order Form with TRU-Balance® 3 Positioning

Quantum® Rehab401 York Ave., Duryea, PA 18642Phone: 866-800-2002 | Fax: 866-707-3422 | Email: [email protected]

Account Number: ___________ Date: ________________

Provider Name: __________________________________

Contact: ________________________________________

Phone: ___________________ Fax: _________________

Email: __________________________________________

PO Number: _____________________________________

Marked for: _____________________________________

Ship to Address: _________________________________

City: _____________________ State: ______ Zip: ______

Weight:________ Height:________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

A. Shoulder Width: _______B. Chest Width: _________C. Hip Width: ___________

D. Max Sitting Height: ____E. Shoulder Height: ______F. Axilla Height: _________

G. Thigh Depth: _________H. Lower Leg Length: ____I. Elbow Height: ________

This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. Com-plete the form by placing checks in the desired boxes and provide information in the interactive fields. Buttons shown at the bottom of the form may be utilized to print or submit the order form through a desktop email application. To email via a web-based application, please ‘Save As’ and attach the PDF to your email. This order form contains a large variety of options to fulfill various patient needs. Descriptions and section notes, such as optional or required, are included to help you complete your order. Please contact Quantum Sales at 866-800-2002 if assistance is needed. Send the completed order form by fax (866-707-3422) or email ([email protected]). Incomplete forms may delay the quote or order. Customer service will contact you if the order is incomplete or if there are compatibility issues. If special order requests are needed, be sure that the Patient Information section is completed or include a completed physical assessment form with this order form. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for deter-mining the appropriate billing codes when submitting for insurance reimbursement. Payer coding, coverage, and bundling guidelines may apply. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete power chair. Please contact technical service for accurate parts ordering.

Thank you for choosing Quantum!

INTRODUCTION

PATIENT INFORMATION

1. BASE MODELREQUIRED. Select a group 3 power base. 450 lb. weight capacity with standard 4.7 mph programmable motors, 8 amp off board charger, and unoccupiedtransit loops. Dimensions of base without legrests: 26”Wx36.75”L.

Quantum Q6 Edge HD 3HD-SS ........................................$8,595Part: Q6 EDGEHD 3HD-SS. HCPCS: K0850Solid seat pan standard with no power option.

Quantum Q6 Edge HD 3SPHD-SS .....................................$8,595Part: Q6 EDGEHD 3SPHD-SS. HCPCS: K0858Single power option.

Quantum Q6 Edge HD 3MPHD-SS ....................................$8,595Part: Q6 EDGEHD 3MPHD-SS. HCPCS: K0862Multiple power option.

https://get.adobe.com/reader/

mailto:quantumorders%40pridemobility.com?subject=

http://www.quantumrehab.com/resources/downloadorderforms.php?f=seating/us_physical_assessment_form.pdf


Account Number: ___________ Date: ________________ Marked for: _____________________________________2. BASE COLORREQUIRED. Select one shroud color. Colors shown here may differ from actual product depending on monitor/printer calibration used.

Red CorvettePart: DGN169178-PRD1

Electric BluePart: DGN169178-PBU9

Back in BlackPart: DGN169178-PBK1

Night TrainPart: DGN169178-PBK3

Pretty in PinkPart: DGN169178-PPK3

Evolution OrangePart: DGN169178-POR7

Deep PurplePart: DGN169178-PPR5

Grey StreetPart: DGN169178-PSL3

Midnight BluePart: DGN169178-PBU10

Green MachinePart: DGN169178-PGN11

3. FENDER LIGHTSOptional. Fender lights operate by pressing included single switch button. Fender lighting is not available with NE 4-Key Joystick or Single Actuator Control through Toggle Box.

6. BATTERIESOptional. The powerchair requires 2 batteries and will be installed if ordered.

Group 24, 70 Amp Gel Cell, Interceptor Battery ............. $365 ea.Part: BAT1704614. HCPCS: E2363

Group 24, 70 Amp Gel Cell, MK Battery ........................ $495 ea.Part: BATGEL1009. HCPCS: E2363

3" x 14” Run Flat Tires .............................................. StandardPart: PTOINDV3510

3" x 14” Flat Free Tires ........................................... No ChargePart: WHL124116 x2

3" x 14” Pneumatic Tires ......................................... No ChargePart: WHL124117 x2

4” x 14" Flat Free, Knobby, Extended Traction Tires .... $275.50 ea.Part: WHL121698 x2

4” x 14" Pneumatic, Knobby, Extended Traction Tires .. $275.50 ea.Part: WHL121703 x2

5. DRIVE WHEELSREQUIRED. Select a type of drive wheels and accent color. Knobby tires increase overall base width by 1.5”.

5.1. Drive Wheels

Electronics section continued on following page.

5.2. Drive Wheel Accent ColorOptional. Not available with knobby tires.

Switch Fender Lights without Lift System ........................... $250Part: XRF000177

Switch Fender Lights with Lift System ........................ No ChargePart: DGN154117

Back in Black Accent Color..............$59.95Part: XRF000179

Red Corvette Accent Color .............$59.95Part: XRF000180

Electric Blue Accent Color ..............$59.95Part: XRF000188

Night Train Accent Color ................$59.95Part: XRF000181

Pretty in Pink Accent Color .............$59.95Part: XRF000185

Evolution Orange Accent Color ........$59.95Part: XRF000186

Deep Purple Accent Color ...............$59.95Part: XRF000184

Grey Street Accent Color ................$59.95Part: XRF000182

Midnight Blue Accent Color .............$59.95Part: XRF000187

Green Machine Accent Color ...........$59.95Part: XRF000190

1. Optional Mounting Bracket

4. QUANTUM BACKUP CAMERAOptional. The backup camera may interfere with armrest mounted accessories such as media device holder.

Quantum Backup Camera ............................................................................................................. $350Part: MEC1910365

Backup Camera Headrest Bracket .....................................................................................................$20Part: MEC1910373Works with .5" x .5" vertical supports only.

Backup Camera

NE+ 6 Key Joystick

NE 4-Key Joystick ....................................StandardPart: CTLDC1554Available with Static Seat or Tilt Only through Toggle.

NE+ 6-Key Joystick ................................No ChargePart: CTLDC1560Control of one actuator through Joystick on single power base model (3SPHD-SS) only.

No Joystick, Setup for NE+ Joystick ...........No ChargePart: XRF000009

NE+ 6-Key Joystick ......................................$200Part: XRF000001Control up to 2 actuators through joystick.

NE+ 8-Key Joystick .......................................$400Part: CTLDC1561Control up to 2 actuators and LED, Full Light Package through joystick.

7.1a. Non-Expandable ControlsSelect a joystick below or omit selection if another controller type is desired. Non-expandable does not allow supplementary drive controllers.

7. ELECTRONICSREQUIRED. Select a type of drive control from the following sections. The No Joystick option is used to omit the joystick and utilize another control, such as a specialty control at the end of this form or found on the Alternative Controls and Electronics Order Forms.

http://www.quantumrehab.com/resources/downloadorderforms.php?f=electronics/us_alternative_controls_order_form.pdf


Left Side MountPart: PTOINDV1225

Right Side MountPart: PTOINDV1226

9.2. Joystick Mount Location

9.1c. Specialty Joystick MountsSelect a bracket and side to mount it.

Retract4 Mount ............................................$350Part: XRF000003. HCPCS: E1028Full 180° of movement that translates into multi-position use, straight, right offset, left offset, or fold away. Joy-stick orientation varies as bracket is adjusted.

Multi-Axis Mount .......................................... $120Part: XRF000004Allows height adjustment of joystick.

Stealth Swing-Away/Flip Down Bracket ..........$294.25Part: XRF000005. HCPCS: E1028Allows the joystick to pivot to side of armrest,or flip-down if bracket is adjusted.

Account Number: ___________ Date: ________________ Marked for: _____________________________________

Black, Soft Touch ................. StandardPart: DGN124307

Non-matching Shroud ...................$60Part: PTOINDV3422Select color below

Match Shroud .............................$60Part: PTOINDV3421

Red CorvettePart: DGN124336-PRD1

Electric BluePart: DGN124336-PBU9

Back in BlackPart: DGN124336-PBK1

Night TrainPart: DGN124336-PBK3

Pretty in PinkPart: DGN124336-PPK3

Evolution OrangePart: DGN124336-POR7

Deep PurplePart: DGN124336-PPR5

Grey StreetPart: DGN124336-PSL3

Midnight BluePart: DGN124336-PBU10

Green MachinePart: DGN124336-PGN11

1. Q-Logic 3 Required ComponentsQ-Logic 3 expandable controls require the controller module and expandable harness below. If a Q-Logic joystick or specialty control is selected later in this form, Customer Service will quote the order with these items.

2. Q-Logic 3 Joystick

7.1b. Expandable Controls - Quantum Intelligent Systems™Select expandable controls or omit selection if another controller type is desired. Expandable controls allow multiple or specialized controllers. This sections allows a selection of common configurations.

7.2. Q-Logic 3 Joystick ArmorREQUIRED with Q-Logic 3 Joystick selections above. Reference colors shown on page 2.

8. JOYSTICK HANDLESOptional. The NE/NE Plus joysticks are standard with a carrot handle (See A in image). The standard Q-Logic 3 joystick knob can be seen in the image in section 7.1b. The optional handle will be mounted to the joystick and the standard handle will be shipped with the unit.

Joystick Handles

Joystick mounting brackets section continued on following pages.

Q-Logic 3 EX Controller Module .......................$695Part: XRF000002. HCPCS: E2377

Q-Logic 3 Expandable Controller Harness ...........$425Part: XRF000264. HCPCS: E2313

Mushroom Handle (B) ..................................... $85Part: ACCASMB1860. HCPCS: E2323

Chin Cup (C) ................................................. $85Part: ACCASMB1861. HCPCS: E2323 (E2324 when chin control)

T-Bar (D) .................................................... $120Part: ACCASMB1858. HCPCS: E2323

Medium Ball Handle (E) ................................... $65Part: ACCASMB1859. HCPCS: E2323

Soft Ball Handle (F) ........................................ $65Part: ACCASMB1856. HCPCS: E2323

Extended I-Handle (G) .................................... $85Part: ACCASMB1857. HCPCS: E2323

Bodypoint 3” Goal Post Handle ......................... $99Part: PLSKNCP1057. HCPCS: E2323

Bodypoint 4” Goal Post Handle ......................... $99Part: PLSKNCP1058. HCPCS: E2323

Q-Logic 3 Carrot Handle (A) .....................No ChargePart: DGN124308

7. ELECTRONICS continued

Q-Logic 3 Joysticks

3 EX 3eQ-Logic 3e Joystick ......................................$700Part: CTL1910600Can operate full light package. Not available with alter-native or specialty controls.

Q-Logic 3 EX Joystick ....................................$800Part: CTL167724

Q-Logic 3 EX Joystick for Full Lights .................$800Part: CTL167725

No Joystick, Setup for Q-LogicPart: XRF000010

9.1a. Fixed, In-line Joystick BracketFixed, In-line, Bracket for Q-Logic 3 ............StandardPart: FRMASMB10617

Fixed, In-line, Bracket for NE/NE+ ...............StandardPart: FRMASMB12744

9.1b. Swing-Away (Retractable) Joystick BracketAllows the joystick to retract to the side of the armrest while maintaining the same joystick orientation.

Swing-away, Q-Logic 3 ...................................$280Part: ACC1908434. HCPCS: E1028

Swing-away, NE/NE+ ......................................$280Part: ACC1908437. HCPCS: E1028

Swing Away Joystick

Multi-Axis JoystickMount

Retract4

9. JOYSTICK MOUNTING BRACKETSOptional. Select a mount to be used with a joystick selected in previous section.


Spectrum Foam SPP, Matching Seat SizeReference part: XRF000112. MSRP: $460/$530

Stealth Spectrum Foam SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner.Part series: ST-SPCFSPPXXYY. HCPCS: E2607/E2608

Solution SPP, Matching Seat SizeReference part: XRF000113. MSRP: $375/$430

Stealth Solution SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner.Part series: ST-SOLSPPXXYY. HCPCS: E2607/E2608

Stealth Essence SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover.Part series: ST-ESSSPPXXYY. HCPCS: E2607/E2608

Essence SPP, No Wedge, Matching Seat SizeReference part: XRF000118. MSRP: $400/$500

Essence SPP, Small Wedge, Matching Seat SizeReference part: XRF000119. MSRP: $435/$535

Essence SPP, Medium Wedge, Matching Seat SizeReference part: XRF000120. MSRP: $465/$565

Essence SPP, Large Wedge, Matching Seat SizeReference part: XRF000121. MSRP: $495/$595

10.8. Matching Seat CushionOptional. Specific cushion/component sizes available, part numbers, weight capacities, MSRP, HCPCS code, and special order cushions can be found on the re-spective complete Stealth Cushion Order Forms. This section allows a quick selection of a single cushion that matches the seat pan width and depth. See specific order form for non-matching sizes, alternate covers and liners, or additional covers and liners.

Simplicity G, Matching Seat SizeReference part: XRF000111. MSRP: $110/$165

Stealth Simplicity G CushionGeneral use cushion with Stealth Tek 2, 2-way stretch, breathable cover.Part series: ST-SIMGXXYY. HCPCS: E2601/E2602

Glacial SP, Matching Seat SizeReference part: XRF000114. MSRP: $330/$440

Stealth Glacial SP CushionSkin protection with Coolcore, 4-way stretch, breathable cover.Part series: ST-GLSPXXYY. HCPCS: E2603/E2604

Premiere P, Matching Seat SizeReference part: XRF000122. MSRP: $325/$475

Stealth Premiere P CushionPositioning with Coolcore, 4-way stretch, breathable cover.Part series: ST-PREMPXXYY. HCPCS: E2605/E2606

Zen SP, Matching Seat SizeReference part: XRF000115. MSRP: $315/425

Stealth Zen SP CushionSkin protection with Coolcore, 4-way stretch, breathable cover.Part series: ST-ZENSPXXYY. HCPCS: E2603/E2604

10.7. Seat to Floor HeightREQUIRED.

Lowest Seat to FloorPart: PTOINDV3558

Middle Seat to FloorPart: PTOINDV3559

Highest Seat to FloorPart: PTOINDV3560


10.1. TRU-Balance 3 ConfigurationTRU-Balance 3 Static Seat ............................................$2,295Part: PTOINDV344220° of limited recline adjustment (-5/ +15) via gas strut within back cover.

TRU-Balance 3, Heavy Duty, Power Tilt ........................... $7,995Part: PTOINDV3643. HCPCS: E100250° Center of Gravity (CG) power tilt seating system.

TRU-Balance 3 Heavy Duty, Power Recline .......................$8,595Part: PTOINDV3645. HCPCS: E1004175° of power recline.

TRU-Balance 3 Heavy Duty, Power Tilt & Recline ............. $12,895Part: PTOINDV3644. HCPCS: E100750° CG power tilt with 175° of power recline. Full drive lockout at 20°.

TRU-Balance 3 Seating section continued on following pages.

10.2. 10" Power LiftOptional.

TRU-Balance 3, Heavy Duty, 10” Power Lift with iLevel® and Fender Lights ............................................ $2,600Part: PTOINDV3797. HCPCS: E2300400 lb weight capacity. 24”W x 24”D maximum seat size. Includes fender lights found in section 5.

10.3. Seat WidthREQUIRED. Maximum non-lift seat width is 32"W. *Widths over 24" are not available with 10" power lift. Part number is SETWDTH plus number following # below.

20” W(#1010)

21” W(#1011)

22” W(#1012)

23” W(#1013)

24” W(#1014)

25” W*(#1056)

26” W*(#1054)

27” W*(#1057)

28” W*(#1055)

29” W*(#1058)

30” W*(#1059)

31” W*(#1060)

32” W*(#1061)

10.4. Seat Width PackageREQUIRED.

20”-24” Width PackagePart: XRF000158



16”-20” Depth PackagePart: XRF000013Minimum Seat Depth is 20"

20”-24” Depth PackagePart: XRF000159Use with 25" Depth

20” D(#1010)

21” D(#1011)

22” D(#1012)

23” D(#1013)

24” D(#1014)

25” D(#1060)

10.6. Seat Depth PackageREQUIRED.

10.5. Seat DepthREQUIRED. Maximum seat depth is 25". Part number is SETDPTH plus number following # below.

10. TRU-BALANCE® 3 SEATING - Quantum Intelligent Systems™REQUIRED. Maximum seat size is 32"W x 25"D.

TRU-Balance 3Seat to Floor Heights

18.5” 19.5” 20.5”

16.5” 17.5” 18.5”

Low Med High

Tilt, Tilt & Recline, Lift

Static Seat, Recline

https://www.quantumrehab.com/pdf/order-forms/seating/us_stealth_spectrum_foam_order_form.pdf

https://www.quantumrehab.com/pdf/order-forms/seating/us_stealth_solution_order_form.pdf

https://www.quantumrehab.com/resources/quantum-order-forms.asp

https://www.quantumrehab.com/pdf/order-forms/seating/us_stealth_simplicity_order_form.pdf


TRU-Comfort 4 Back Cushion, 20” Width or Less .......................................................................................................................$675HCPCS: E2620. Select size below. Height is overall. Part number is SET plus number following #.

1b. TRU-Comfort Back Selection

Tilt:16"-17"H,Recline:19"-20"HPart: #124601














18" Wide, 16"-20"Width Package:








20" Wide, 20"-24" Width Package:

10.11. Back Cushion ConfigurationREQUIRED. Select a configuration type and applicable dimensions. See the Sport, Q-Back, and TRU-Comfort back availability chart for stock order back size ranges. Other size backs may be available with special order and extended lead time.

Sport Back ........................................................... No ChargePart: XRF000017Complete following width package and size.

Omit Back Pan/Cushion ........................................... No ChargePart: PTOINDV1287Select a following width package.

After-market Back Interface ........................................... $200Part: XRF000018Select a back width within a range of 16"-24"W. Overall seat depth may need to be adjusted to accommodate certain backs. May inter-fere with gel/waterfall armpads and arm through. Does not include brackets to mount after-market backs.

10.10. Back Cane Selection (Back Cane Option Only)REQUIRED when Back Cane Option is selected above. Select type and height of back canes.

2. Back Cane Height

1. Back Cane TypeAngle Adjustable ...................No ChargePart: MEC140266

1” Endo....................................... $70Part: XRF000269

2” Endo ...................................... $70Part: XRF000271

16” High CanePart: FRMASMB15834






10.9. Back Type SelectionREQUIRED. Match choice in this section with the options in the following back cushion configuration section.

TRU-Balance 3 Back Assembly (Static Back)Part: XRF000194Select a back cushion configuration in the subsequent section.

Back Cane OptionPart: XRF000015Available only with TRU-Balance 3 Static Seat and Power Tilt selec-tions. Select back cane type, back cane height, and back cushion con-figuration.

Flip Forward Back..........................................................$175Part: XRF000220Available with Static Seat and Power Tilt (1 actuator). Only available with 2-post, flip back or pediatric armrests. Not available with 12”-14” width. Select a back cushion type in the subsequent section.


10. JOYSTICK MOUNTING BRACKETS continued

TRU-Balance 3 Seating section continued on following page.

TRU-Comfort 2 SPP, Matching Seat SizeReference part: XRF000116. MSRP: $400/$500

Stealth TRU-Comfort 2 SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover.Part series: ST-TC2SPPXXYY. HCPCS: E2607/E2608

Spectrum Gel SPP, Matching Seat SizeReference part: XRF000117. MSRP: $460/$530

Stealth Spectrum Gel SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner.Part series: ST-SPCGSPPXXYY. HCPCS: E2607/E2608

TRU-Comfort 2 or 4 Back Cushion, 22” Width .......................................................................................................................... $775HCPCS: E2621. Select size below. Height is overall. Part number is SET plus number following #. Sizes of 24" or greater may be TRU-Comfort 2 style back cushion until inventory is depleted.
















1a. Sport Back/Omit/After-Market Interface

https://www.quantumrehab.com/pdf/order-forms/seating/us_stealth_trucomfort_2_order_form.pdf

https://www.quantumrehab.com/pdf/order-forms/seating/us_stealth_spectrum_gel_order_form.pdf


10.14. Back Width PackageREQUIRED except when Omit Back Pan/Cushion is selected. Available with +/-4” of seat width.

Match Seat Width SelectionsPart: PTOINDV3468

16”W-20”W PackagePart: XRF000038




10.12. TRU-Balance 3 Back ShroudREQUIRED. The back shroud is a feature of the TRU-Balance 3 seating system and is available in matching shroud colors. The back shroud is not available when Omit Back Pan/Cushion is selected. Reference colors shown in section 2.

10.13. Lateral Positioning WedgeOptional.

Lateral Positioning Wedge, pair ......................................................................................................................................... $30Part: SET123465Available with Sport and TRU-Comfort 2 backs. Not available on power tilt backs 16”-17”H with limited adjustability on 18” H. Not available on power recline back 19”-20”H with limited adjustability on 21”H.

Red CorvettePart: XRF000019

Back in BlackPart: XRF000021

Night TrainPart: XRF000022

Grey StreetPart: XRF000023

Deep PurplePart: XRF000025

Pretty in PinkPart: XRF000027

Evolution OrangePart: XRF000028

Midnight BluePart: XRF000029

Electric BluePart: XRF000030

Green MachinePart: XRF000033









10. TRU-BALANCE 3 SEATING continuedTRU-Comfort 2 or 4 Back Cushion, 22” Width continued.

1e. Q-Back 2.0, AL Series, Extra Deep ContourNot available with Back Cane Option. Select a back type and the specific overall back height in subsequent section.

Deep Contour, 18"Wx19-20"H Tilt/22"-23" H Recline ............. $595Part: QB2AL18DS. HCPCS: E2620

Deep Contour, 18"Wx21-22"H Tilt/24"-25" H Recline ............. $595Part: QB2AL18DT. HCPCS: E2620

Deep Contour, 18"Wx23-24"H Tilt/26"-27" H Recline ............. $595Part: QB2AL18DX. HCPCS: E2620

Deep Contour, 18"Wx25-26"H Tilt/28"-29" H Recline ............. $595Part: QB2AL18DXX. HCPCS: E2620

Deep Contour, 20"Wx19-20"H Tilt/22"-23" H Recline ............. $595Part: QB2AL20DS. HCPCS: E2620

Deep Contour, 20"Wx21-22"H Tilt/24"-25" H Recline ............. $595Part: QB2AL20DT. HCPCS: E2620

Deep Contour, 20"Wx23-24"H Tilt/26"-27" H Recline ............. $595Part: QB2AL20DX. HCPCS: E2620

Deep Contour, 20"Wx25-26"H Tilt/28"-29" H Recline ............. $595Part: QB2AL20DXX. HCPCS: E2620

Extra Deep Contour, 18"Wx19-20"H Tilt/22"-23" H Recline ..... $595Part: QB2AL18ES. HCPCS: E2620

Extra Deep Contour, 18"Wx21-22"H Tilt/24"-25" H Recline ...... $595Part: QB2AL18ET. HCPCS: E2620

Extra Deep Contour, 18"Wx23-24"H Tilt/26"-27" H Recline ..... $595Part: QB2AL18EX. HCPCS: E2620

Extra Deep Contour, 18"Wx25-26"H Tilt/28"-29" H Recline ..... $595Part: QB2AL18EXX. HCPCS: E2620

Extra Deep Contour, 20"Wx19-20"H Tilt/22"-23" H Recline ..... $595Part: QB2AL20ES. HCPCS: E2620

Extra Deep Contour, 20"Wx21-22"H Tilt/24"-25" H Recline ..... $595Part: QB2AL20ET. HCPCS: E2620

Extra Deep Contour, 20"Wx23-24"H Tilt/26"-27" H Recline ..... $595Part: QB2AL20EX. HCPCS: E2620

Extra Deep Contour, 20"Wx25-26"H Tilt/28"-29" H Recline ..... $595Part: QB2AL20EXX. HCPCS: E2620

1d. Q-Back 2.0, AL Series, Deep ContourNot available with Back Cane Option. Select a back type and the specific overall back height in subsequent section.

1c. Q-Back 2.0, AL Series, Active ContourNot available with Back Cane Option. Select a back type and the specific overall back height in subsequent section.

Active Contour, 18"Wx19-20"H Tilt/22"-23" H Recline ............ $525Part: QB2AL18AS. HCPCS: E2613

Active Contour, 18"Wx21-22"H Tilt/24"-25" H Recline ............ $525Part: QB2AL18AT. HCPCS: E2613

Active Contour, 18"Wx23-24"H Tilt/26"-27" H Recline ............ $525Part: QB2AL18AX. HCPCS: E2613

Active Contour, 18"Wx25-26"H Tilt/28"-29" H Recline ............ $525Part: QB2AL18AXX. HCPCS: E2613

Active Contour, 20"Wx19-20"H Tilt/22"-23" H Recline ............ $525Part: QB2AL20AS. HCPCS: E2613

Active Contour, 20"Wx21-22"H Tilt/24"-25" H Recline ............ $525Part: QB2AL20AT. HCPCS: E2613

Active Contour, 20"Wx23-24"H Tilt/26"-27" H Recline............ $525Part: QB2AL20AX. HCPCS: E2613

Active Contour, 20"Wx25-26"H Tilt/28"-29" H Recline............ $525Part: QB2AL20AXX. HCPCS: E2613

TRU-Balance 3 Seating section continued on following page.


10.17. Power Tilt Privacy FlapOptional. A privacy flap is standard with power recline systems. This selection is to add a flap for power tilt only systems.

Privacy Flap, 9.75” .........................................................$45Part: DWR1044E456B

Privacy Flap, 12.75” .......................................................$45Part: DWR1044E456A

10.15. Back WidthREQUIRED except when Omit Back Pan/Cushion is selected. Part number is PTOINDV plus number following # below. Available with +/-4” of seat width.

18” W(#3566)

19” W(#3567)

20” W(#3568)

21” W(#3569)

22” W(#3570)

24” W(#3571)

26” W(#3572)

28” W(#3573)

30” W(#3574)

32” W(#3575)

Tilt or Static Back Width Recline Back Width

Sport and TRU-Comfort 2 Back Availability Chart

Ove

rall

Back

Hei

ght

Sport or TRU-Comfort 2 BackSport Back

10.16. Overall Back HeightStatic Seat and Power Tilt available height range: 16”-25”H. Odd heights include 4” gap and even heights include 3” gap between seat pan and bottom of back cushion. Power Recline available height range: 19”-28”H. Odd heights include 6” gap and even heights include 7” gap. See the Sport and TRU-Comfort back availability chart for stock order back size ranges.

16” Overall HeightPart: SETHGHT1029













10. TRU-BALANCE 3 SEATING continued


11.3. Armrest SizeREQUIRED with armrest selection above. Select a left (L) and right (R) armrest size. This also affects armpad selection.

10” LengthL part: XRF000057. R part: XRF000123

14” LengthL part: XRF000058. R part: XRF000124

17” LengthL part: XRF000059. R part: XRF000125Only available with Flip-Back Armrests and straight arm pads.

11.2. Armrest HeightSet left and right armrest height. Note the available height range in the option description.1. Left Armrest Height

2. Right Armrest Height

11.1b. Height Adjustable, Removable, Heavy Duty ArmrestsSelect a type of HD removable armrests and the set height in the following section. Only one height package is selectable as a normal configuration. Payer coding, coverage, and bundling guidelines may apply.

8”-12”H, Single Post, Height Adjustable, Removable, .........$75 ea.Heavy Duty (Sold in pairs)Part: XRF000055. HCPCS w/ Static Seat: E0973

10”-14”H, Single Post, Height Adjustable, Removable,........$75 ea.Heavy Duty (Sold in pairs)Part: XRF000056. HCPCS w/ Static Seat: E0973

8” HPTOINDV3535

9” HPTOINDV3536

10” HPTOINDV3537

11” HPTOINDV3538

12” HPTOINDV3539

13” HPTOINDV3540

14” HPTOINDV3541

15” HPTOINDV3542

16” HPTOINDV3543

8” HPTOINDV3450

9” HPTOINDV3451

10” HPTOINDV3452

11” HPTOINDV3453

12” HPTOINDV3454

13” HPTOINDV3455

14” HPTOINDV3456

15” HPTOINDV3457

16” HPTOINDV3458

Flip-Back, 22"-26"Widths, 8"-16"H Armrests .............. StandardLeft part: ARM2004694. Right part: ARM2004693

Flip-Back, 26"-32"Widths, 8"-16"H Armrests .............. StandardLeft part: ARM2004696. Right part: ARM2004695

11.1a. Flip-Back, 8"-16" H ArmrestsChoose a left and right armrest and set height in the following section. Flip-back armrests include an armrest downpost on the Q6 Edge HD. Not available with waterfall armpads. Not available with Back Cane Option.

11. TRU-BALANCE 3 ARMRESTSREQUIRED. Select the desired type of armrest below. Please read notes to ensure seating compatibility. Be sure to also select an armrest size and armpad type.


12.1a. Omit ArmpadSelect one below if aftermarket armpads or handpads are required. See Positioning Components Order Form.


12.1c. Gel ArmpadsSold only in pairs. Armpads are 3” wide. Manufacturer part number for full length is 314G and desk length is 310G.

12. TRU-BALANCE 3 ARMPADSREQUIRED with armrest selection above except for Drop-In, T-Arm. Please note that waterfall and gel armpads may cause interference with the seat back.

12.1b. Foam Armpads

b. Falcon Gel Armpads for Tube Style Armrests

No Armpad Selection .............................................. No ChargePart: XRF000060Not available with Flip-back, 8"-16" H armrests.

Interface for Aftermarket Pad .................................. No ChargePart: XRF000308Only available with Flip-back, 8"-16" armrests.

Straight, Armpad ................................................ StandardLeft part: XRF000061. Right part: XRF000126

Waterfall, Armpad ............................................ No ChargeLeft part: XRF000062. Right part: XRF000127Not available with Flip-back, 8"-16" armrests.

13. TRU-BALANCE 3 JOYSTICK BRACKET RECEIVERREQUIRED.

Standard Fixed Receiver ........................................... StandardPart: XRF000063

Stealth Height Adjustable Receiver ................................... $214Part: XRF000064. HCPCS: K0108

Falcon Gel, Full Length Left and Right ............................... $185Part: ARM1806807

Falcon Gel, Full Length Left, Desk Length Right ............... $162.50Part: ARM1806813

Falcon Gel, Desk Length Left, Full Length Right ............... $162.50Part: ARM1806810

Falcon Gel, Desk Length Left and Right ............................. $140Part: ARM1806806

a. Falcon Gel Armpads for Flip-Back Armrests

Falcon Gel, Full Length Left and Right ........................... $296.40Part: ARM136438

Falcon Gel, Full Length Left, Desk Length Right ............... $274.22Part: ARM136442

Falcon Gel, Desk Length Left, Full Length Right ............... $274.22Part: ARM136439

Falcon Gel, Desk Length Left and Right ......................... $252.40Part: ARM136437

15.1b. Optional Lap Belts

15.1a. Standard Lap Belts

15. LAP BELTSREQUIRED. Select a lap belt below.

38” Lap BeltPart: ACCBELT1006






Stealth Retractable Lap Belt (IFRB5350) ..............................$175Part: ST-IFRB5350

Stealth Positioning, 60” Single Pull, Push Button, Medium........$86(7.5”) Padded, 1.5” Belt (IFPB5213)Part: ST-IFPB5213-Q

Stealth Positioning, 60” Single Pull, Push Button, Large ..........$86Padded (9.5”), 2” Belt (IFPB5314)Part: ST-IFPB5314-Q

Stealth Positioning, 60” Single Pull, Push Button, Extra Large ...$86Padded (11.5”), 2” Belt (IFPB5315)Part: ST-IFPB5315-Q

Multi-Axis Removable Headrest Bracket (HMO475P) ...........................................................................................................$160.50Part: HDWASMB1084. HCPCS: E1028

Stealth 8” Comfort Plus (CP450) ....................................$151.94Part: POS148484. HCPCS: E0955

Stealth 10” Comfort Plus (CP250) ..................................$151.94Part: SETHEAD1057. HCPCS: E0955

Stealth 14” Comfort Plus (CP150) ..................................$151.94Part: INDPART2327. HCPCS: E0955

Pediatric Comfort Plus (6”Wx4.5”H) (CPN350) ..................$151.94Part: SETHEAD1069. HCPCS: E0955

1. Headrest Pads

2. Headrest Brackets

14.1b. Headrests, Comfort Plus

1. Headrest Pads

2. Headrest Brackets

14.1a. Headrests, Comfort Plus with Cool Core

Stealth 8” Comfort Plus, Cool Core (CP08CCFPM) ..................$167Part: ST-CP08CCFPM-Q. HCPCS: E0955

Stealth 10” Comfort Plus, Cool Core (CP10CCFPM) .................$167Part: ST-CP10CCFPM-Q. HCPCS: E0955

Stealth 14” Comfort Plus, Cool Core (CP14CCFPM) .................$167Part: ST-CP14CCFPM-Q. HCPCS: E0955

Stealth 6", Comfort Plus, Cool Core (CP06CCFPM) ..................$167Part: ST-CP06CCFPM-Q. HCPCS: E0955

Comfort Plus Headrest Mounting Bracket, UniLink ................................................................................................................ $294Part: ST-UHB2D33200-Q. HCPCS: E1028

14. TRU-BALANCE 3 HEADRESTSOptional. Select a headrest pad and bracket.

http://www.quantumrehab.com/resources/downloadorderforms.php?f=seating/us_positioning_components_order_form.pdf


4. Modular Footplate Extension ComponentsOptional. Assembly required. May require seating configuration adjustments to avoid front caster interference.

Width Extension for 8”D Footplates ...................................$65Part: RIG152517

Width Extension for 11”D Footplates ..................................$65Part: RIG152518

2” Bell-Shaped Length Extension .......................................$65Part: RIG152519Not compatible with width extensions. Can be used with 6” outside edge with 11” footplates.

4” Outside Edge (pair) .....................................................$65Part: RIG152510Only available with 6”D footplates and 8”D footplate extension.

6” Outside Edge (pair) .....................................................$65Part: RIG152516Available with 8”D and 11”D footplates and 11”D footplate extension.

No interference issues at this seat-to-floor height.

May have less than 1.75” clearance when fully extended and may interfere with the ground or reduce obstacle climbing ability.

Center Mount Foot Platform Compatibility Matrixfor TRU-Balance® 3

Power Reclineor Static Seat

Low Med. High Low Med. High Low Med. High

Power Tilt Power Lift

10”-16” Length Extension

13”-19” Length Extension

3a. Center Mount Calf PadsCalf pads are standard with a power articulating foot platform.

3b. Center Mount Calf PanelCalf pads are standard with a power articulating foot platform.

Small Calf Pads, AFP Only, 6”Wx6”H (pair) .................... StandardPart: RIGASMB7120018

Small Calf Pads, Manually Adjustable Center Mount Only, ...... $1506”Wx6”H (pair)Part: XRF000156

Large Calf Pads, AFP Only, 8” taper to 6"Wx8”H (pair) ..... StandardPart: RIGASMB7120019

Large Calf Pads, Manually Adjustable Center Mount Only, ..... $1508” taper to 6"Wx8”H (pair)Part: XRF000157

Small Calf Panel for AFP, 18”Wx8”H ...................................$175Part: FRMASMB7110007

Large Calf Panel for AFP, 24”Wx8”H ................................. $225Part: RIG123824Only available on widths of 20” or greater.

Small Calf Panel for Manually Adjustable, 18”Wx8”H .............$175Part: FRMASMB7110012

Large Calf Panel for Manually Adjustable, 24”Wx8”H ............ $225Part: RIG123825Only available on widths of 20” or greater.


Legrests section continued on following page.

Base Mounted Foot Platform ...................................... StandardPart: FRMASMB16077

Base Mounted, Bell Shaped Foot Platform ................... No ChargePart: RIGASMB7120041

Omit Base Mounted Foot Platform ............................. No ChargePart: PTOINDV3674

17.1a. Center Mount Foot PlatformIf power articulating foot platform is selected, be sure power legrest control has been selected in earlier section. Select legrest length in following section.

2. Lower Extension and Angle Adjustable Footplates

1. Foot Platform AssemblyPower Articulating Foot Platform .................. $2,995Part: PTOINDV3754. HCPCS: E1012+K0040

Manually Adjustable Center Mount ...................$250Foot Platformpart: XRF000155. HCPCS: K0040 Power Articulating

Foot Platform

10"-16" Extension, 5"x6" FootplatesPart: RIG150206






16. BASE MOUNTED FOOT PLATFORMREQUIRED. Select a foot platform option. A base mounted foot platform is not available with center mount foot platforms. May interfere with seat mounted legrests.

17. LEGRESTSOptional. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. Reference the section’s compatibility matrix for legrest interference.


1. Heavy Duty, Elevating Legrest Selection

2. Lower Extension

3. Reinforced Footplates(s)

4. Angle Adjustable Footplates(s) with Heel Loops

17.1c. Heavy Duty, Elevating LegrestsSelect a configuration, a legrest, extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.

Heavy Duty, Elevating Legrest(s) with Calf Pad(s) ............................................................................................... $162.50 ea.Pair part: FRMASMB6702. Left: FRMASMB8444. Right: FRMASMB8445. HCPCS: E0990

7.25”Wx6”D Extruded Footplate ........................ StandardPart pair: FRMASMB4748. Left: RIG138055. Right: RIG138056

8.5”Wx6”D Extruded Footplate ......................... StandardPart pair: FRMASMB4747. Left: RIG138060. Right: RIG138062

6”Wx8”D .......................................................$85 ea.Pair part: FRMASMB4738. Left: RIG137793. Right: RIG137795.HCPCS: K0040+E0951

6”Wx11”D ......................................................$85 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797.HCPCS: K0040+E0951

8”Wx11”D ......................................................$85 ea.Pair part: FRMASMB4744. Left: RIG137798. Right: RIG137799.HCPCS: K0040+E0951May cause interference with seat widths less than 20"

11”-14” LengthPart: FRMASMB4755. Left: RIG138026. Right: RIG138030For reinforced footplates only.

8.5"-12" HD Drop-Ins/12.5"-16.5" ELR, Ext LengthPair part: XRF000101. Left: XRF000102. Right: XRF000103.For angle adjustable footplates only.

14”-17” LengthPart: FRMASMB4756. Left: RIG138033. Right: RIG138035For reinforced footplates only.

13"-18" HD Drop-Ins/15.5"-19.5" ELR, Ext Length Pair part: XRF000104. Left: XRF000105. Right: XRF000106For angle adjustable footplates only.

17.1b. Heavy Duty, Drop-In, Swing-Away LegrestsSelect a configuration, a legrest, extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.

70° HD Drop-in for 8.5"-12" Lower Extension ..... No ChargePair part: FRMASMB4762. Left: RIG137706. Right: RIG137707

70° HD Drop-in 13"-18" or 16"-21" Lower ............ No Charge Extension

Pair part: FRMASMB4853. Left: RIG137708. Right: RIG137709

6”Wx8”D1 ......................................................$85 ea.Pair part: FRMASMB4738. Left: RIG137793. Right: RIG137795.HCPCS: K0040+E0951

6”Wx11”D1 .....................................................$85 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797.HCPCS: K0040+E0951May cause interference on seat widths less than 18".

8”Wx11”D2 .....................................................$85 ea.Pair part: FRMASMB4744. Left: RIG137798. Right: RIG137799.HCPCS: K0040+E0951May cause interference on seat widths less than 20".

1. Drop-In Legrest Selection

3. Angle Adjustable Footplate(s) with Heel Loops

8.5"-12" HD Drop-Ins/12.5"-16.5" ELR, Ext LengthPair part: XRF000101. Left: XRF000102. Right: XRF000103.

13"-18" HD Drop-Ins/15.5"-19.5" ELR, Ext Length Pair part: XRF000104. Left: XRF000105. Right: XRF000106

16"-21" HD Drop-Ins/18.5"-22.5" ELR, Ext Length Pair part: FRMASMB4754. L: FRMASMB4725. R: FRMASMB5393

2. Lower Extension

Small Reversed Dartex Calf Pad Cover (pair) ....................... $200Part: RIG133717

Large Reversed Dartex Calf Pad Cover (pair) ....................... $200Part: RIG133719

Small Reversed Dartex Panel Cover (pair) ........................... $200Part: RIG134673

Large Reversed Dartex Panel Cover (pair) .......................... $200Part: RIG134744

Footplate Connector ....................................................... $15Part: RIGASMB7120023

5. Center Mount Additional Accessories

5"x8" Tapered Gel Footplate Covers .................................. $205Part: ST-FPG5008T-Q. HCPCS: K0108

5"x11" Tapered Gel Footplate Covers ................................. $225Part: ST-FPG5011T-Q. HCPCS: K0108

5"x8" Tapered Gel Footplate Covers for Width Extension ....... $225Part: ST-FPG6508T-Q. HCPCS: K0108

5"x11" Tapered Gel Footplate Cover for Width Extension ....... $250Part: ST-FPG7011T-Q. HCPCS: K0108

6. Stealth Gel Footplate Covers


Legrests section continued on following page.

17. LEGRESTS continued


18.2. 4-Function Push Button/iAccess MountREQUIRED with 4-function push button and iAccess options. Under arm mount is not available with TRU-Balance 3 HD armrests.

Joystick Mount ..................................................... No ChargePart: MEC1907500

Under Arm Mount, Flip-Back Armrest ......................... No ChargePart: MEC1906531

Under Arm Mount, Tube Style Armrest ....................... No ChargePart: MEC1906530

Attendant Mount ............................................................$25Part: MEC1906564

Under Arm Mount, Flip-Back Armrest, plus iAccess Guard ........$25Part: MEC2001400

Under Arm Mount, Tube Style Armrest, plus iAccess Guard ......$25Part: MEC2001401

1. Under Arm Mount Side SelectionLeft Side Under Arm MountPart: PTOINDV3678

Right Side Under Arm MountPart: PTOINDV3679

18.1d. Q-Logic 3 Controls with iAccess Switch ControliAccess control is not available with combined or independent power legrests.

Single Actuator Control, Through Flat Button ....................$2,425iAccess and Q-Logic 3 Controller and Interface (AM1)Part: XRF000070. HCPCS: E2310

Single Actuator Control, Through Flat Button ....................$3,295iAccess and Q-Logic 3 Controller and Interface (AAM)Part: XRF000071. HCPCS: E2310

Multiple Actuator Control Through Flat Button ..................$3,295iAccess and Q-Logic 3 Controller and Interface (AAM)Part: XRF000072. HCPCS: E2311

Single Actuator Control, Through Toggle Button ................$2,425iAccess and Q-Logic 3 Controller and Interface (AM1)Part: XRF000073. HCPCS: E2310

Single Actuator Control, Through Toggle Button ................$3,295iAccess and Q-Logic 3 Controller and Interface (AAM)Part: XRF000074. HCPCS: E2310

Multiple Actuator Control Through Toggle Button ...............$3,295iAccess and Q-Logic 3 Controller and Interface (AAM)Part: XRF000075. HCPCS: E2311

Left Side TogglePart: PTOINDV1839

Right Side TogglePart: PTOINDV1838

1. Toggle Mount Side Selection

17.2. Set Legrest Extension LengthREQUIRED with matching left and right legrest configuration. Part number is PTOINDV plus number following # below. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. Reference the section’s compatibility matrix for legrest interference. Non-matching or individual legrest configurations lengths are not set by the manufacturer.

8.5” L(#3473)

9” L(#3474)

9.5” L(#3475)

10” L(#3476)

10.5” L(#3477)

11” L(#3478)

11.5” L(#3479)

12” L(#3480)

12.5” L(#3481)

13” L(#3482)

13.5” L(#3483)

14” L(#3484)

14.5” L(#3485)

15” L(#3486)

15.5” L(#3487)

16” L(#3488)

16.5” L(#3489)

17” L(#3490)

17.5” L(#3491)

18” L(#3492)


17. LEGRESTS continued

18.1a. Tilt Only through Toggle

18. TRU-BALANCE 3 POWER POSITIONING ELECTRONICSREQUIRED with power seating or legrest options.

Single Actuator Control, Power Tilt Only, Through Toggle (NE 4-Key Joystick Only) ................................................................No ChargePart: ELE1905907Select toggle side. May require extended lead time when selected with Fender Lights.

18.1c. Q-Logic 3 Controls through Joystick

18.1b. NE+ 6 Key Controls through Joystick

Switch Controls

4 Way Toggle

4 Way ButtonToggle

4 FunctionPush Button

iAccessFlat Button

iAccessToggle Button

Single Actuator Control Through NE+ Joystick .. $2,060Part: XRF000065. HCPCS: E2310

Two Actuator Control Through NE+ Joystick .... $2,895Part: XRF000066. HCPCS: E2311

Single Actuator Through Q-Logic 3 ................ $2,060Controller and Interface (AM1)Part: XRF000067. HCPCS: E2310

Single Actuator Through Q-Logic 3 ................ $2,895Controller and Interface (AAM)Part: XRF000068. HCPCS: E2310

Multiple Actuator Through Q-Logic 3.............. $2,895Controller and Interface (AAM)Part: XRF000069. HCPCS: E2311

4-Function Push ButtonPart: CTL123218See following section for switch mounting.

4-Way TogglePart: ELEASMB5925

4-Way Button TogglePart: ELEASMB5926

1. Optional Switch ControlNot available with AM1 electronics. 4-Way switches will be mounted to same side of joystick.

19. TRU-BALANCE 3 ATTENDANT CONTROLOptional. *Attendant control will be at no charge when ordered with Tilt and Recline, alternative drive controls, and a Q-Logic Display or SCIM module. Mounting bracket is included.

Attendant Control ........................................................ $500Part: XRF000078. HCPCS: E2331Select this option if no charge option criteria is not met.

Attendant Control with Tilt, Recline, Alternative .......... No ChargeControls and Q-Logic Display or SCIM ModulePart: XRF000079



20 FULL LIGHT PACKAGEOptional. Requires NE+ 8 Key or Q-Logic 3 Joystick for Full Light Package.

Seat Mounted, LED, Full Light Package .............................................................................................$995Part: XRF000130

Seat Mounted LEDLights (One Shown)

21. ACCESSORIESOptional. Multiple accessories can be mounted along the various tracks but some interference may occur. Accessories may need to be mounted by the provider.

TRU-Balance 3Accessories

TRU-Balance 3 Cane/Crutch Holder ..................$100Part: ACC152515. HCPCS: E2207

Quantum Backpack ....................................... $160Part: ACC1905853

Grip Lap Board (20005)............................... $38.95Part: ACC152992

Grip Drink Holder (20085) ........................... $15.50Part: ACC152993

TRU-Balance 3 Hydration System (B) .................$225Part: ACC125010

TRU-Balance 3 Transfer Handle (D) .............. $100 ea.Part: MEC1809930. HCPCS: E0705Not available with Heavy Duty armrests.

TRU-Balance 3 Cup Holder .......................No ChargePart: ACC125003For use with TRU-Balance 3 (track style) armrests.

Cup Holder (Tube-style Armrest) ...............No ChargePart: ACCASMB2634For use with tube-style armrests.

TRU-Balance 3 Personal Item Hook .................... $65Part: ACC125008Not available with back cane option.

TRU-Balance 3 Reflector Kit ............................. $50Part: ACC124670

TRU-Balance 3 Backpack Holder (Pair) (A) ........... $65Part: ACC147774Not available with back cane option.

TRU-Balance 3 Front Mounted .......................... $65Cell Phone/ Media Holder, X-Grip (E)Part: ACC155835Not available with Heavy Duty armrests.

TRU-Balance 3 Rear View Mirror ....................... $65Part: ACC155833Not available with Heavy Duty armrests.

TRU-Balance 3 Oxygen Holder .........................$200Part: ACC125006. HCPCS: E2208Includes accessory bar, a credit will be applied PTOIN-DV3769.

TRU-Balance 3 Clothing Guard (Pair) .................$225Part: ACC125007Not available with Heavy Duty armrests.

TRU-Balance 3 Glove Box (C) ........................... $150Part: ACC125011

Stealth Large Tablet Holder ............................$375Part: ACC141818Not available with Heavy Duty armrests.

Trilogy Vent Tray ..........................................$400Part: ACC136791. HCPCS: E1029Includes accessory bar, a credit will be applied PTOIN-DV3769. Contact custom for models other than 100 and 200.

Compact Vent Tray .....................................$1,395Part: ACC133889. HCPCS: E1029

Push Handles (pair) ....................................... $185Part: ACC2005027Not available with oxygen holder, back cane option, or vent tray. Required with attendant manual recline.

Accessory Bar .............................................. $125Part: ACC1909634Horizontal rail attached to rear of seat. Standard with the Trilogy vent tray and oxygen holder. Not available with back cane option.

Large, Black, Weather Cover ...........................$202Part: ACCCOVR1021

Q-Logic EX/NE Programmer ............................$545Part: ELEASMB6976

Privacy Bag ...............................................$39.95Part: ACC1907570

VOCSN Vent Tray for Power Tilt, Seat Mount .......$895Part: ACC2000162. HCPCS: E1029

VOCSN Vent Tray for Power Lift, Seat Mount .......$895Part: ACC2000159. HCPCS: E1029

VOCSN Vent Tray for Accessory Bar Mount ..........$895Part: ACC2000166. HCPCS: E1029Includes accessory bar, a credit will be applied PTOIN-DV3769.

Flip-Back Armrest, Side Track Accessory Bracket ...$10Part: MEC1809178Only available with flip-back, 8"-16" H armrests. This adds a 47mm channel to the side of the armrest to allow mounting of accessories with t-nuts.

Personal Item Pouch ...................................$79.95Part: ACC2101017

Compact and Trilogy


2. Pelvic/Thigh Guide Adapter2” Height Adapter Plate (LHW-122) .................................$26.25Part: INDPART2821. HCPCS: K0108Height adapter is needed with TRU-Comfort seat cushions. Not avail-able with the flip down bracket.

2 1/4” Adapter Plate (LHW-129) .....................................$53.50Part: POS140430. HCPCS: K0108Only available with the flip down full surface bracket.

1. Pelvic/Thigh Guide Bracket

23.3. Stealth Pelvic/Thigh GuidesPelvic/thigh guides may interfere with the joystick receiver block and down posts. Please provide quantity next to check box.

Flip Down Bracket (TWBTLADD-HW) ................... $236.25 ea.Part: INDPART2804. HCPCS: E1028

Removable Bracket (LP430) ............................... $262.50 ea.Part: INDPART2805. HCPCS: E1028

Removable Bracket with 1” Offset .......................... $400 ea. (LP430 & LHW-121)

Part: INDPART2854. HCPCS: E1028

Flip Down with LEFT Full Surface Contact ................. $236.25 ea.Feature (TWBADD-L & LPHW407)Part: POS140428. HCPCS: E1028

Flip Down with RIGHT Full Surface Contact ................ $236.25 ea.Feature (TWBADD-R & LPHW407)Part: POS140429. HCPCS: E1028


Military Patches

22. BRANCH PATCHESOptional.

Air Force Patch .................. $20Part: ACC140240

Army Patch ....................... $20Part: ACC140241

Coast Guard Patch .............. $20Part: ACC140239

Marines Patch .................... $20Part: ACC140243

Navy Patch ....................... $20Part: ACC140244

Purple Heart Patch ............. $20Part: ACC140238

Positioning components section continued on following page.

1. Thoracic Lateral Bracket

2. Thoracic Lateral Pads

3. Thoracic Lateral Installation

Swing-away, Rail Mounts, pair (TWBTLTC) ...................................................................................................................... $472.50Part: INDPART2677. HCPCS: E1028

Curved Pads, 3”x5”, pair (TWBL-3X5) ................................ $210Part: INDPART2663. HCPCS: E0956

Curved Pads, 4”x6”, pair (TWBL-4X6) ................................ $210Part: INDPART2664. HCPCS: E0956

Flat Pads, 3”x5”, pair (TWBLP3X5) ................................... $210Part: INDPART2676. HCPCS: E0956

Flat Pads, 4”x6”, pair (TWBLP4X6) ................................... $210Part: INDPART2675. HCPCS: E0956

23.1. Stealth Thoracic LateralsSwing-away laterals may interfere with TRU-Balance 3 armrests and 2-post, flip up armrests. These laterals are not available with the back cane option.

23. POSITIONING COMPONENTSOptional. More options are available on the Positioning Components Order Form.

Install LateralsPart: PTOINDV3499

Do Not InstallPart: PTOINDV3500

4. UniLink Pelvic/Thigh Guide Installation

1. UniLink Pelvic/Thigh Hardware

2. UniLink Pelvic/Thigh Pads

3. UniLink Pelvic/Thigh Additional Links

23.2. Stealth UniLink Pelvic/Thigh Guide

UniLink, 5" Height Adjustable & Removable Hardware ... $245 ea.Part: ST-UTTP5-Q. HCPCS: K01028

UniLink, 7" Height Adjustable & Removable Hardware... $255 ea.Part: ST-UTTP7-Q. HCPCS: K01028

UniLink Pad & Hardware

Install on LeftPart: PTOINDV3585

Install on RightPart: PTOINDV3586


UniLink, 4" x 4" Pad ..............................$95 ea.Part: ST-UTP544056100-Q. HCPCS: E956

UniLink, 4" x 8" Pad ............................. $105 ea.Part: ST-UTP548056100-Q. HCPCS: E956

UniLink, 4" x 12" Pad ........................... $125 ea.Part: ST-UTP54D056100-Q. HCPCS: E956

UniLink, 1.5" Link ............................... $75 ea.Part: ST-UIL00I150A000-Q

UniLink, 2" Link ................................... $75 ea.Part: ST-UIL00I200A000-Q

http://www.quantumrehab.com/resources/downloadorderforms.php?f=seating/us_positioning_components_order_form.pdf


23.9. Stealth Padded Shoe HolderStealth Small Padded Shoe Holder, 3.75"Wx6.25"D ............... $266(SPLE111) (pair)Part: INDPART2783. HCPCS: E0951+E0952

Stealth Medium Padded Shoe Holder, 4"Wx8.25"D ................ $266(SPLE112) (pair)Part: INDPART2784. HCPCS: E0951+E0952

Stealth X-Large Padded Shoe Holder, 5"Wx10.75"D ............... $266(SPLE114) (pair)Part: INDPART2785. HCPCS: E0951+E0952

23.8. Stealth Foot BoxesStealth Small Foot Boxes, 5"Wx8"Dx7"H ......................... $498.75(SPLE107) (pair)Part: INDPART2786. HCPCS: E0954

Stealth Medium Foot Boxes, 6"Wx10"Dx9"H .................... $498.75(SPLE108) (pair)Part: INDPART2787. HCPCS: E0954

Stealth Large Foot Boxes, 7"Wx12"Dx11"H ...................... $498.75(SPLE109) (pair)Part: INDPART2788. HCPCS: E0954

23.5. Stealth Positioning Chest Straps

Chest Strap

23.4. Stealth Positioning Chest Harness

Contoured and ClassicChest Harness

Upper Classic, Medium (IFPS1103) ............... $142 ea.Part: ST-IFPS1103-Q. HCPCS: E0960

Upper Classic, Large (IFPS1104) .................. $142 ea.Part: ST-IFPS1104-Q. HCPCS: E0960

Upper Contour, Medium (IFPS2103) .............. $142 ea.Part: ST-IFPS2103-Q. HCPCS: E0960

Upper Contour, Large (IFPS2104) ................ $142 ea.Part: ST-IFPS2104-Q. HCPCS: E0960

Chest Strap, Medium w/ Belt Anchor, (IFCS4113) ..$90 ea.Part: ST-IFCS4113-Q. HCPCS: E0960

Chest Strap, Large w/ Belt Anchor, (IFCS4114) ....$90 ea.Part: ST-IFCS4114-Q. HCPCS: E0960

23.6. Stealth Swing-Away Headrest MountsThese swing-away headrest mounts are only available with the Stealth Comfort Series headrests.

Left and Right FacialLateral with Pads

1. Facial Lateral HardwareFacial Lateral for Comfort Series .............$294.25 ea.Right Side (CPS9-R-HW)Part: INDPART2647. HCPCS: E1028

Facial Lateral for Comfort Series .............$294.25 ea.Left Side (CPS9-L-HW)Part: INDPART2648. HCPCS: E1028

Facial Laterals for Comfort Series ........... $347.75 ea.Left and Right Side (CPS9-B-HW)Part: INDPART2649. HCPCS: E1028

Headrest Accessories

2. Facial Lateral Pads and AccessoriesEgg Switch Mount (ESM) (A) ................ $52.50 ea.Part: INDPART2815

Figure 8 Bracket with 13" Rod ............ $267.50 ea. and Egg Switch Mount (B)

Part: ST-F8675-13-Q

Facial Pad, 4"x2" (900-Q)................... $53.50 ea.Part: ST-900-Q. HCPCS: K0108

Facial Pad, 6"x2" (920-Q) ................... $53.50 ea.Part: ST-920-Q. HCPCS: K0108

Swing-Away Joystick Mount, 18" Rod (C) .... $250 ea.Part: ST-SUS18-Q Allows mounting of facial pads and attaches to the headrest

3. Pelvic/Thigh Guide Pad

4. Pelvic/Thigh Guide InstallationInstall on LeftPart: PTOINDV3585

Install on RightPart: PTOINDV3586


Short Pad, 4”x4” (TWBADD-4X4) ..............................$75 ea.Part: INDPART2801. HCPCS: E0953/E0956

Medium Pad, 4”x8” (TWBADD-4X8) ...........................$75 ea.Part: INDPART2802. HCPCS: E0953/E0956

Long Pad, 4”x12” (TWBADD-4X12) ............................$75 ea.Part: INDPART2803. HCPCS: E0953/E0956


23. POSITIONING COMPONENTS continued

2. Elbow Support Pad

1. Elbow Support Bracket23.7. Stealth Elbow Support

Left,Swing-Away, Elbow Support ........ $183.75 ea. Bracket Tube Style Arms (ARMS-ES-L)

Part: POS124064. HCPCS: E1028

Left, Fixed Elbow Support Bracket ...... $183.75 ea. TRU-Balance 3 Arms (ARMS-ESFTB3-L)

Part: POS133465

Right, Swing-Away, Elbow Support ...... $183.75 ea. Bracket Tube Style Arms (ARMS-ES-R)

Part: POS124066. HCPCS: E1028

Right, Fixed Elbow Support Bracket .... $183.75 ea. TRU-Balance 3 Arms (ARMS-ESFTB3-R)

Part: POS133466

3"Wx3"H Elbow Pad (ARMS-ES-3X3) ...... $52.50 ea.Part: POS124065. HCPCS: K0108

4"Wx4"H Elbow Pad (ARMS-ES-4X4) ...... $52.50 ea.Part: POS124067. HCPCS: K0108

Elbow Supports


Egg Switch

Red Egg Switch (ESRED) .......................... $80.85Part: SWTMCRO1077

Blue Egg Switch (ESBLU) ......................... $80.85Part: SWTMCRO1079

Black Egg Switch (ESBLK) ........................ $80.85Part: SWTMCRO1081

Green Egg Switch (ESGRN) ...................... $80.85Part: SWTMCRO1078

Yellow Egg Switch (ESYEL) ...................... $80.85Part: SWTMCRO1080

24.6. Egg Switches

Sip & Puff Straws, 12 pack (SP625-S12).............$32.10Part: ST-SP625-S12-Q

Sip & Puff Bus Cable ......................................$425Part: DWR1111H046

3. Sip & Puff Accessories

Stealth Sip and Puff for Comfort Series, .........$294.25Left Mount (SP625-CL)Part: ST-SP625-CL-Q. HCPCS: E2326 Includes straw and mounting hardware. Use with Stealth Comfort Plus headrests.

Stealth Sip and Puff for Comfort Series, .........$294.25Right Mount (SP622-CR)Part: ST-SP625-CR-Q. HCPCS: E2326Includes straw and mounting hardware. Use with Stealth Comfort Plus headrests.

Stealth Sip and Puff for Stealth i-Drive, .........$294.25Head Array (SP625-U)Part: ST-SP625-U-Q. HCPCS: E2326 Includes straw and mounting hardware. Use with Stealth i-Drive Head Arrays.

Stealth Sip & Puff

2. Sip and Puff Straw and MountThe straw and mount do not include electrical components to operate the Sip&Puff with a head array. This component requires the selection of a Q-Logic Sip&Puff module or additional module from Stealth Products for operation.

Sip and Puff Module for Q-Logic 3 ..................................................................................................$1,895Part: CTL168056. HCPCS: E2325 Includes module and mounting hardware. Sip & Puff Module

24.5. Sip and Puff Drive1. Sip and Puff Module

24.3. Q-Logic 3 SAJQ-Logic 3 EX SAJ .........................................................................................................................$700Part: CTL143980Must be used in conjunction with Enhanced Display or Q-Logic 3 Joystick.

EX SAJ

24.2. SCIM ModuleOptional.

SCIM Module Kit for Q-Logic 3......................................................................................................... $525Part: CTL168055Allows use of joystick display for specialty devices. Available with Q-Logic 3 EX Joystick selection above. Up to 5 profiles to control drive, seat, and auxiliary functions, excluding sip-n-puff and single switch functions. A switch is required to operate the input device attached to the SCIM module.

SCIM Module

24.4. Head ArrayAdult, i-Drive Tri-Array Series, 3-Switch ......... $4,414Head Array (IDHBT200-1)Part: ST-IDHBT200-1-Q. HCPCS: E2330Features bluetooth, head support, 3 non-proportional proximity sensors for drive control, an egg switch for re-set mode change, and i-Drive smart box.

Adult, i-Drive Pro Series Head Array .............. $4,461(IDHBT300-1)Part: ST-IDHBT300-1-Q. HCPCS: E2330Features bluetooth, head support with occipital pad and 2 swing-away spot pads for left and right side, 3 non-pro-portional proximity sensors, an egg switch for reset mode change, and i-Drive smart box.

Adult Pro-Series

Enhanced DisplayQ-Logic 3 Enhanced Display ShroudRequired with Q-Logic 3 Enhanced Display selection above. Reference colors shown on page 2.

Black, Soft Touch ..... StandardPart: DGN137728

Red Corvette ..................$60Part: DGN137729-PRD1

Back in Black ..................$60Part: DGN137729-PBK1

Night Train .....................$60Part: DGN137729-PBK3

Grey Street ....................$60Part: DGN137729-PSL3

Deep Purple ...................$60Part: DGN137729-PPR5

Pretty in Pink .................$60Part: DGN137729-PPK3

Midnight Blue .................$60Part: DGN137729-PBU10

Electric Blue ..................$60Part: DGN137729-PBU9

Green Machine ...............$60Part: DGN137729-PGN11


24.1. Enhanced DisplayQ-Logic 3 Enhanced Display Kit .................................................................................................$1,884.93Part: CTL167726Select a color option below. Includes enhanced display, flexible gooseneck and mounting bracket. Features: 3.5” LCD display; up to 5 profiles to control drive, seat, and auxiliary functions; Bluetooth connectivity for mobile devices and mouse emulation; integrated single switch scanner; IR controls.

24. ALTERNATIVE CONTROLS AND ELECTRONICSOptional. Select a type of specialty controls below. More options are available on the Alternative Controls and Electronics order form.

Alternative controls and electronics section continued on following page.

http://www.quantumrehab.com/resources/downloadorderforms.php?f=electronics/us_alternative_controls_order_form.pdf


24.7. Switch Adapter2 to 1 Switch Adapter .................................................................................................................................................. $13.39Part: DWR1361H037 Connects 2 single switches to a stereo jack to act as a dual switch.

24.8. Environmental Controls

24.9. USB Mobile Device Charger

Q-Logic 3 ECU Module Kit .......................................................................................................... $2,400Part: CTL168057

USB Mobile Device Charger ............................................................................................................ $175Part: ELE168069Can charge 1 device. A multiplier harness is required and must be added when a Static Seat or Power Tilt Only seating system is chosen. The selection of more than 3 modules requires an additional multiplier.

USB MediaDevice Charger


25. TRU-BALANCE 3 MULTIPLIER HARNESSREQUIRED. Multiple controllers or power accessories may require an additional multiplier harness or special order. Reference the chart below to determine the appropriate selection. The rows refer to the total amount of arm mounted devices and the columns refer to the total amount of back mounted devices. The online order configurator will automatically make this selection under specialty controls.

Secondary Multiplier (SM) ........................................... $221.21Part: XRF000107

1 Arm 2 Arm 3 Arm 4+ Arm

1 Back0 Back

2 Back3+ Back

NANASMSOF

SMSMSMSOF

SMSMSMSOF

SOFSOFSOFSOF

Power Positioning Chart

1 Arm 2 Arm 3 Arm 4+ Arm

1 Back0 Back

2 Back3+ Back

NA

NA No additional MultiplierSecondary MultiplierSpecial Order Required

NASM

SM SOFSOF

SMSMSMSOF

SOFSOFSOFSOF

SOFSOFSOFSOF

Static Seat Chart

Q-Logic 3 Multiplier Charts

Arm

Mou

nts Joystick (Hand Control)

Enhanced DisplayiAccessUSB ChargerSAJ

Back

Mou

nts

Attendant ControlSCIMSip n PuffECU

24. ALTERNATIVE CONTROLS AND ELECTRONICS continued

©2021 Quantum RehabAll rights reserved

facebook.com/QuantumRehab

youtube.com/QuantumRehab

instagram.com/quantum_rehab

twitter.com/quantumrehab

https://www.facebook.com/QuantumRehab

https://www.youtube.com/user/QuantumRehab

https://www.instagram.com/quantum_rehab/

https://twitter.com/quantumrehab

Quantum Q6 Edge HD Order Form with TRU-Balance 3 …

Documents

Transcript of Quantum Q6 Edge HD Order Form with TRU-Balance 3 …