frame - ki mobility · phone (800) 981-1540 | fax (715) 254-0996 [email protected] | dcn0131.7...

Company: ________________________________________________

Account Number: __________________ Date: _________________

q Quote q PO Number: ___________________________________

RTS: _____________________________________________________

Marked For: _______________________________________________

Ship To: __________________________________________________

Address: _________________________________________________

City: ________________________________ State: _____________

Zip: ________________ Phone: _____________________________

Email/Fax: ________________________________________________

Frame

q Liberty FT - Transit Included E1161 _________________________ $3115250 lb weight capacity. Tilt range: 0º - 20º.

q Liberty FT - Transit Not Included E1161 _______________ $2795250 lb weight capacity. Tilt range: 0º - 20º.

Phone (800) 981-1540 | Fax (715) [email protected] | www.kimobility.com

DCN0131.8 Pricing and specifications subject to change without notice of 6

Select Seat Depth within desired Seat Depth Range

Seat Depth Range Seat Depth

q Short14” - 16”

q 14 q 15 q 16

N/C N/C N/C

q Medium16” - 18”

q 16 q 17 q 18

N/C N/C N/C

q Long18” - 20”

q 18 q 19 q 20

N/C N/C $605

E2203

Seat Depth Range / Seat DepthSelect Seat Width within desired Seat Width Range

Seat WidthRange

Seat Width

q Small14” - 18”

q 14 q 15 q 16 q 17 q 18

N/C N/C N/C N/C N/C

q Medium16” - 20”

q 16 q 17 q 18 q 19 q 20

N/C N/C N/C N/C $470

E2201

q Large18” - 22”

q 18 q 19 q 20 q 21 q 22

N/C N/C $470 $470 $470

E2201 E2201 E2201

Seat Width Range / Seat Width

Seat Option

q Standard Seat Sling ___________________________________________________________________________ Stdq Omit Seat _____________________________________________________________________________________________ N/C

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.

Assistive Gas Strut Set-UpClient Weight Setting Spring Type (Newtons)

q > 200 lbs 1 450 N

q 176 - 200 lbs 2 450 N

q 151 - 175 lbs 1 3 450 N

q 151 - 175 lbs 2 1 300 N

q 125 - 150 lbs 2 300 N

q < 125 lbs 3 300 N1 Standard on chairs less than 16” deep2 Standard on chairs 16” deep or larger

This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows.

Effective 02/08/2021

Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________

Transit

q Transit System _________________________________________________________________________________ $320No charge when selected with Liberty FT - Transit Included

q Omit Transit __________________________________________________________________________________________ N/C

q Liberty FT - Rigid, Transit Included E1161 __________ $3115250 lb weight capacity. Tilt range: 0º - 20º.

q Liberty FT - Rigid, Transit Not Included E1161 ___ $2795250 lb weight capacity. Tilt range: 0º - 20º.

Phone (800) 981-1540 | Fax (715) 254-0996

[email protected] | www.kimobility.com


Footrest

Footplate

q Composite _____________________________________________________________________________________________ StdNot available with Front Mount Hanger or PRO ELR

q Composite Angle Adjustable ________________________________________________________ $175Not available with Front Mount Hanger or 14” Seat Width

q Aluminum Angle Adjustable K0040 _____________________________________________ $190q Aluminum Locking Multi-Angle Adjustable K0108 __________________ $300

Available only with Front Mount Hanger

q One Piece Flip Up Angle Adjustable K0040 ______________________________ $190Not available with Front Mount Hanger or PRO ELR

Back UpholsteryIf selecting both upholstery and Axiom Back, the upholstery will be installed.

q Standard ________________________________________________________________________________________________ Stdq Tension Adjustable E2611 ______________________________________________________________ $245

Not available on Seat Widths less than 16” combined with 21” and 22” Backrest Heights

q Omit Back Upholstery ___________________________________________________________________ - $15

Military Patch

Backrest

Backrest Options

q Fixed (Non-Folding) ____________________________________________________________________________ Std

q Angle Adjustable (Folding) _______________________________________________________________ $95

Stroller Handle Back Post OptionAvailable only with Stroller Handle Back Post

q Removable Stroller Handle Extension _________________________________________ $75

Back Post Price Height Range Back Height

q Stroller Handle Back Post 1 Stdq Short q 20

q Tall q 24

q Height Adjustable Straightwith Push Handle

$25

q Short q 14 q 15 q 16 q 17 q 18

q Medium q 16 q 17 q 18 q 19 q 20

q Tall q 18 q 19 q 20 q 21 q 22

q Height Adjustable 8º Bendwith Push Handle 2

$25

q Short q 14 q 15 q 16 q 17 q 18

q Medium q 16 q 17 q 18 q 19 q 20

q Tall q 18 q 19 q 20 q 21 q 221 Not available with Back Upholstery2 Not available with IV Pole

Back Post / Height Range / Back Height

Attached only if ordered with Tension Adjustable 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

Hanger 60º 70º 80º 90º Retail

Extension Tube Mount q q q1 N/C

Front Mount q q1 q2 N/C

Pro Elevating Leg Rests(PRO ELR) E0990, Rental K0195

q $295

Omit Hangers q -$201 Not avaliable with 8” casters2 Not avaliable with 8” casters in combination with 3” extension

Hanger

PRO ELR CoverAvailable only on PRO ELR

q Gel Pad Cover New! ________________________________________________________________ $340

Phone (800) 981-1540 | Fax (715) 254-0996


Heel LoopNot available with One Piece Flip Up Angle Adjustable Footplate

q Heel Loops E0951 ______________________________________________________________________________ $35q Omit Heel Loops ________________________________________________________________________________ N/C

Calf Strap

q Velcro Adjustable K0038 ___________________________________________________________________ $35q Padded Velcro Adjustable K0038 __________________________________________________ $68q Bodypoint Padded AeroMesh K0038 _________________________________________ $115

Footrest continued

Residual Limb Support


Footrest / Extension / Seat to Footrest LengthSelect Extension and Seat to Footrest Length in row corresponding to desired Footrest. Footrest Length of at least 2.5” shorter than Seat Height recommended. Extension Tube Hanger measurements based on 70º Hanger Bend.

Footrest Extension Seat to Footrest Length

Extension TubeHangers(60º, 70º, 80º)

q Short q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5

q Medium q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 q 15.5

q Long q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18

FrontMountHangers 1

Standard Selections Requires 3” Extension

q Short(70º, 80º, 90º)

q 5 q 5.5 q 6 q 6.5 q 8.5 q 9 q 9.5

q 7 q 7.5 q 8 q 10 q 10.5 q 11

q Medium(70º, 80º, 90º)

q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 10.5 q 11 q 11.5

q 8 q 8.5 q 9 q 9.5 q 10 q 12 q 12.5 q 13

q Long(70º, 80º)

q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 8.5 q 12.5 q 13 q 13.5

q 9 q 9.5 q 10 q 10.5 q 11 q 11.5 q 12 q 14 q 14.5 q 15

PRO ELR Low Pivot Setting

q Short 10.5 - 15.5

q Long 13 - 19

PRO ELR High Pivot Setting

q Short 8.5 - 17

q Long 11.5 - 17.51 See Minimum Seat Height chart below

Minimum Seat Height with Front Mount Hangers

Hanger Length Short Medium Long

Hanger Bend 70º 80/90º 70º 80/90º 70º 80º

Minimum Seat Height with Standard Selection

13” 13” 13” 13.5” 14.5” 15.5”

Minimum Seat Height with 3” Extension

13.5” 14“ 15.5” 16” 17” 18”

3” ExtensionAvailable only with Front Mount Hangers.

q 3” Extension ________________________________________________________________________________________ N/Cq 3” Extension (Provided as Parts) ___________________________________________________ N/C

Residual Limb Support E1020

q Right and Left ______________________________________________________________________ $790 q Left _____________ $395 q Right ____________ $395 q Omit Left Hanger _ -$10 q Omit Right Hanger _ -$10

Cover ______________________________________________ q Smooth q Air Mesh q Smooth q Air Mesh

Pad Size ___________________________________________ q 5 x 8 q 9 x 14 q 5 x 8 q 9 x 14 q 7 x 10 q 11 x 10 q 7 x 10 q 11 x 10 q 9 x 10 q 11 x 14 q 9 x 10 q 11 x 14

Hanger Release

q 4-Way - In line ______________________________________________________________________________________ StdSee reference A below. Not available with PRO ELR.

q 4-Way - Out _________________________________________________________________________________________ N/CSee reference B below.

A B

Seat Height, Casters and Rear Wheels

Seat Height / Caster Size / Rear Wheel SizeSelect Seat Height corresponding to desired Rear Wheel and Caster Size

Phone (800) 981-1540 | Fax (715) 254-0996



RearWheelSize

Caster Size

4” 5” 6” 8”Seat Height

12”

q 13 q 14 q 15

q 13.5 q 14.5 q 15.5 q 17

q 14 q 15 q 16 q 17.5

q 14.5 q 15.5 q 16.5 q 18

q 15 q 16 q 17 q 18.5

q 15.5 q 16.5 q 17.5 q 19 2

q 16 q 17 q 18

q 17.5 q 18.5

q 18 q 19 2

q 18.5

q 19 2

16”

q 13.5 1 q 14 q 15

q 14 1 q 14.5 q 15.5 q 17

q 14.5 q 15 q 16 q 17.5

q 15 q 15.5 q 16.5 q 18

q 15.5 q 16 q 17 q 18.5

q 16 q 16.5 q 17.5 q 19

q 17 q 18 q 19.5

q 17.5 q 18.5 q 20

q 18 q 19

q 18.5

q 19

20”

q 13 q 14 q 15

q 13.5 q 14.5 q 15.5 q 17

q 14 q 15 q 16 q 17.5

q 14.5 q 15.5 q 16.5 q 18

q 15 q 16 q 17 q 18.5

q 15.5 q 16.5 q 17.5 q 19

q 16 q 17 q 18 q 19.5

q 17.5 q 18.5 q 20

q 18 q 19

q 18.5

q 191 Available only with Low Profile tires2 Not available with Full Poly tire3 Not available with Low Profile tires in combination with Mag wheel

RearWheelSize

Caster Size

4” 5” 6” 8”Seat Height

22” 3

q 13.5 1 q 14 q 15

q 14 q 14.5 q 15.5 q 17

q 14.5 q 15 q 16 q 17.5

q 15 q 15.5 q 16.5 q 18

q 15.5 q 16 q 17 q 18.5

q 16 q 16.5 q 17.5 q 19

q 17 q 18 q 19.5

q 17.5 q 18.5 q 20

q 18 q 19

q 18.5

q 19

24” 3

q 14.5 1 q 14.5 1 q 15

q 15 q 15 q 15.5 q 17

q 15.5 q 15.5 q 16 q 17.5

q 16 q 16 q 16.5 q 18

q 16.5 q 17 q 18.5

q 17 q 17.5 q 19

q 17.5 q 18 q 19.5

q 18 q 18.5 q 20

q 18.5 q 19

q 19

Dual - Drum Brake New! _______________________________________________________________ $660Available only with 12” Mag, 16” Mag, or MAXX Performance Spoke wheels. Axle is Quick Release.

q Push to Lock q Pull to Lock

q Omit Wheel Locks _____________________________________________________________________________ N/C

Phone (800) 981-1540 | Fax (715) 254-0996


Rear Tire Type

q Street Pneumatic E2211, E2212 ________________________________________________________ Stdq Full Poly E2218 ____________________________________________________________________________________ N/Cq Pneumatic with Airless Insert E2211, E2213 _________________________________ $80q Euro Trek Knobby E2211, E2212 ______________________________________________________ $95

Available only on 24” wheel size

q Low Poly E2218 ___________________________________________________________________________________ N/CAvailable only with 16” wheel size

q Sentinel Solid Tire E2218 _________________________________________________________________ $95Not available on 12” or 16” wheel sizes or with 20” and 22” Mag wheels

q Schwalbe Marathon Plus Evolution E2211, E2212 ___________________ $125Available only on 24” MAXX Performance wheel

Full Profile

Low Profile

Handrim

q Aluminum Anodized ___________________________________________________________________________ Stdq Plastic Coated ___________________________________________________________________________________ $115q Projection (8 Vertical Projections) ________________________________________________ $325

Available only with full profile tires in combination with 22”-24” MAXX Performance or 24” Mag wheel

q Omit Handrims ____________________________________________________________________________________ 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 ____________________________________________________ $345

Natural Fit Handrims

Handrim Option

Seat Height, Casters and Rear Wheels continued

AxleNo selection needed with Drum Brake

q Fixed ______________________________________________________________________________________________________ N/Cq Quick Release ______________________________________________________________________________________ Std

Wheel Locks

Wheel Lock

Wheel Lock Options

q Push to Lock ________________________________________________________________________________________ Stdq Pull to Lock __________________________________________________________________________________________ N/C

Not available with 12” or 16” Full Poly tires

Hemi Wheel Lock New! _________________________________________________________________ $300Extension Handle included

q Left q Rightq Drum Brake New! _____________________________________________________________________ $560

Available only with 12” Mag, 16” Mag, or MAXX Performance Spoke wheels. Axle is Quick Release.

q Extension Handles E0961 ________________________________________________________________ $67Available 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

Handrims not available on 12” or 16” wheel sizesStandard Handrims

Not available on Plastic Coated or Projection Handrims

q 3M Micro Grip _____________________________________________________________________________________ $65


Caster SizePrice 4” 5” 6” 8”

Cas

ter

Typ

e

1” Poly Std q q q q1” Poly Aluminum $110 q q1” Pneumatic E2214, E2215 $80 q q1.5” Poly $50 q q q1.5” Soft Roll Aluminum $175 q q q2” Poly $70 q2” Pneumatic w/ Foam Insert $225 q

Caster

Rear Wheel SizePrice 12” 16” 20” 22” 24”

Rea

r W

heel

Mag Std q q q q qMAXX Performance Spoke N/C qMAXX Performance Spoke $180 q q

Rear Wheel

Phone (800) 981-1540 | Fax (715) 254-0996



Removable Side Guard

Accessories

Anti-Tip

q Rear Anti-Tips E0971 _______________________________________________________________________ $150q Omit Rear Anti-Tips ___________________________________________________________________________ N/C

Pelvic Positioning Belt

q 1 1/2” Auto Buckle E0978 ________________________________________________________________ $80q 1 1/2” Padded Auto Buckle E0978 _____________________________________________ $170q 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 ___________________________________________________________________________________________________ $55q Removable Underseat Pouch ________________________________________________________ $50q Ki Mobility Backpack ________________________________________________________________________ $65q Black Neoprene Impact Guards ____________________________________________________ $90q Clear Spoke Guards K0065 ___________________________________________________________ $115

Not available with Mag wheel

q Black Spoke Guards K0065 __________________________________________________________ $115Not available with 20” wheel size or Mag wheel

q Cane and Crutch Holder _______________________________________________________________ $195

IV Pole ________________________________________________________________________________________________________ $275Not available with Transit Option or 8º Bend with Push Handle Back Post. Left side mount not available with O2 Holder.

q Right Side q Left Side

O2 Holder

q O2 Holder E2208 _______________________________________________________________________________ $295Mounted to the left side. Not available with Fold Down Back.

q Composite Side Guards K0108 ____________________________________________________ $140Not available with T-Arms

Frame Color

Standard Colors

Belt Mounting Kit

q Seat Belt Mounting Hardware ________________________________________________________ $16q Bodypoint 1” Band Clamp Belt Mounting Kit _________________________ $105

Gloss Finish

q Black ______________________________________________________________________________________________________ N/Cq Candy Blue __________________________________________________________________________________________ N/Cq Candy Purple ______________________________________________________________________________________ N/Cq Candy Red ___________________________________________________________________________________________ N/Cq Copper __________________________________________________________________________________________________ N/Cq Silver ______________________________________________________________________________________________________ N/C

Matte Finish

q Charcoal Gray _____________________________________________________________________________________ N/Cq Iridescent Burgundy __________________________________________________________________________ N/Cq Iridescent Navy ___________________________________________________________________________________ N/Cq Military Green ______________________________________________________________________________________ N/Cq Shadow Black _____________________________________________________________________________________ N/C

Gloss Finish

q Blue Skies ____________________________________________________________________________________________ $70q Bubblegum Pink _________________________________________________________________________________ $70q Granny Smith ______________________________________________________________________________________ $70q Metallic Orange ___________________________________________________________________________________ $70q Teal _________________________________________________________________________________________________________ $70q Yellow _____________________________________________________________________________________________________ $70

Matte Finish

q Emerald Green ____________________________________________________________________________________ $70q Retro Red _____________________________________________________________________________________________ $70q Royal Blue ____________________________________________________________________________________________ $70q Smooth White _____________________________________________________________________________________ $70

Optional ColorsExtended lead time

Armrests

ArmrestHeight Adjustable T-Arm E0973 q Desk (8.5” - 13.5”) ______________________________ $265 q Full (8.5” - 13.5”) _______________________________ $265 Angle Adjustable Locking Extendable Flip Up E0973

Available only with 12” and 16” wheel sizes and Stroller Handle Back Post

q Desk _______________________________________ $275 q Full ________________________________________ $275 q Tubular Flip Up _____________________________________________________________________________________ Std

Available only with Stroller Handle Back Post. Not available with Arm Pads.

q Omit Armrests _____________________________________________________________________________________ N/C

Arm Pad

q Standard Arm Pad _____________________________________________________________________________ N/CNot available with Angle Adjustable Locking Extendable Flip Up Armrests in combination with 20”-24” wheel sizes

q Waterfall Arm Pad ______________________________________________________________________________ $25Not available with Angle Adjustable Locking Extendable Flip Up Armrests

q Foam Grip ____________________________________________________________________________________________ N/CAvailable only with Angle Adjustable Locking Extendable Flip Up Armrest

DCN0537.2 Pricing and specifications subject to change without notice Page 1 of 2

Axiom Cushions

Axiom G Cushion and Extra Outer Cover

Width14” 15” 16” 17” 18” 19” 20” 22”

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

Retail $120 $75 $120 $75 $120 $75 $120 $75 $120 $75 $120 $75 $120 $75 $199 $75HCPC E2601 E2601 E2601 E2601 E2601 E2601 E2601 E2602

Dep

th

14” q q15” q q q q q q16” q q q q q q q q q q q q q q17” q q q q q q q q q q q q q q18” q q q q q q q q q q q q q q q q19” q q q q q q q q q q q q q q20” q q q q q q q q q q q q q q21” q q q q q q q q q q22” q q q q q q q q q q

Phone (800) 981-1540 | Fax (715) 254-0996


Axiom S Cushion and Extra Outer Cover

Width14” 15” 16” 17” 18” 19” 20” 22”

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover


Dep

th


Axiom P Cushion and Extra Outer Cover

Width14” 15” 16” 17” 18” 19” 20” 22”

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover


Dep

th


Weight capacity: 350 lbs

Phone (800) 981-1540 | Fax (715) 254-0996



Axiom Cushions continued Weight capacity: 350 lbs

Axiom SP Visco Cushion and Extra Inner / Outer Cover

Width14” 15” 16” 17” 18” 19” 20” 21” 22”

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer

Retail $430 $105 $430 $105 $430 $105 $430 $105 $430 $105 $430 $105 $430 $105 $525 $105 $525 $105HCPC E2607 E2607 E2607 E2607 E2607 E2607 E2607 E2607 E2608

Dep

th

14” q q q q q q q q q15” q q q q q q q q q q q q q q q16” q q q q q q q q q q q q q q q q q q q q q q q q17” q q q q q q q q q q q q q q q q q q q q q q q q18” q q q q q q q q q q q q q q q q q q q q q q q q q q q19” q q q q q q q q q q q q q q q q q q q q q q q q q q q20” q q q q q q q q q q q q q q q q q q q q q q q q q q q21” q q q q q q q q q q q q q q q q q q q q q q q q22” q q q q q q q q q q q q q q q q q q q q q q q q

Axiom SP Fluid Cushion and Extra Inner / Outer Cover

Width14” 15” 16” 17” 18” 19” 20” 21” 22”

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer

Retail $470 $105 $470 $105 $470 $105 $470 $105 $470 $105 $470 $105 $470 $105 $575 $105 $575 $105HCPC E2607 E2607 E2607 E2607 E2607 E2607 E2607 E2607 E2608

Dep

th

14” q q q q q q q q q15” q q q q q q q q q q q q q q q16” q q q q q q q q q q q q q q q q q q q q q q q q17” q q q q q q q q q q q q q q q q q q q q q q q q18” q q q q q q q q q q q q q q q q q q q q q q q q q q q19” q q q q q q q q q q q q q q q q q q q q q q q q q q q20” q q q q q q q q q q q q q q q q q q q q q q q q q q q21” q q q q q q q q q q q q q q q q q q q q q q q q22” q q q q q q q q q q q q q q q q 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

Select size in chart below. Weight capacity: 350 lbs.

Solid Seat Insert ________________________________________________________________________________________ $60

Solid Seat Insert


Phone (800) 981-1540 | Fax (715) 254-0996


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 $560 $560 $560 $560 $560 $795

HCPC E2613 E2613 E2613 E2613 E2613 E2614

Hei

gh

t Lo

w

8” q AXPB1208 q AXPB1408 q AXPB1608 q AXPB1808 q AXPB2008



Mid




Axiom Posterior Back (PB)

Width

12” 14” 16” 18” 20” 22”Retail $640 $640 $640 $640 $640 $870

HCPC E2615 E2615 E2615 E2615 E2615 E2616

Hei

gh

t

Lo

w

8” q AXPL1208 q AXPL1408 q AXPL1608 q AXPL1808 q AXPL2008



Mid




Tall 20” q AXPL1220 q AXPL1420 q AXPL1620 q AXPL1820 q AXPL2020


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

w8” 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


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


Width

12” 14” 16” 18” 20” 22”Retail $740 $740 $740 $740 $740 $820

HCPC E2620 E2620 E2620 E2620 E2620 E2621

Hei

gh

t

Lo

w

8” q AXLB1208 q AXLB1408 q AXLB1608 q AXLB1808 q AXLB2008



Mid




Tall 20” q AXLB1220 q AXLB1420 q AXLB1620 q AXLB1820 q AXLB2020


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


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 $740 $740 $740 $740 $740 $820

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


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


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


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

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Comfort Plus Headrest 8” HEDPAD408 E0955E1028 q HDR001 $277 q HDR009 $313 q HDR017 $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”


Tri-Comfort Plus Headrest 19”


Headrest Hardware Options


Axiom Back Accessories continued

Available only with Axiom Lateral Back and Axiom Deep Lateral back

Description HCPC Retail

q Lumbar Pad K0108 $48

Lumbar Pads

Description HCPC Retail

q Privacy Flap K0108 $45

Privacy Flap

Phone (800) 981-1540 | Fax (715) 254-0996


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

Axiom Lateral Support Modifications

Extended lead times will apply. Modified Lateral Supports are not eligible for refund.

Description Item Code HCPC Retail

q Modification for Chest Strap attached to Lateral Supports AXMLATMT K0108 N/C


qShoulder Strap Guides and Mount

Selection of a modification from the Axiom Back Modifications required in order to mount Shoulder Guides. Not available with Low Backs.

AXBSG K0108 $75

Shoulder Guides


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.


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.


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 Guides AXMSG K0108 N/C

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 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. Makes back non-refundable.

Phone (800) 981-1540 | Fax (715) 254-0996


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

frame - ki mobility · phone (800) 981-1540 | fax (715) 254-0996 [email protected] | dcn0131.7...

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