option 1: setup by ki mobility frame widthoption 1: setup by ki mobility option 2: setup by frame...
TRANSCRIPT
Company: ________________________________________________
Account Number: __________________ Date: _________________
q Quote q PO Number: ___________________________________
RTS: _____________________________________________________
Marked For: _______________________________________________
Ship To: __________________________________________________
Address: _________________________________________________
City: ________________________________ State: _____________
Zip: ________________ Phone: _____________________________
Email/Fax: ________________________________________________
HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions.
Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer’s coverage policy.
Frame Width
Seating Setup
Select Seat Depth corresponding to desired Frame Depth Range row and Backrest Offset column.Note: All Seat Depths in a column and within the same frame depth range are achievable with future adjustment.
FrameDepthRange
Backrest Offset
q-2 q-1 qFlush q+1 q+2 q+3 q+4
Seat Depth
q Short
q 16 q 15 q 14
q 17 q 16 q 15 q 14
q 18 q 17 q 16 q 15 q 14
q 19 q 18 q 17 q 16 q 15 q 14
q 201 q 19 q 18 q 17 q 16 q 15 q 14
q Medium
q 18 q 17 q 16 q 15 q 14
q 19 q 18 q 17 q 16 q 15 q 14
q 201 q 19 q 18 q 17 q 16 q 15 q 14
q 211 q 201 q 19 q 18 q 17 q 16 q 15
q 222 q 211 q 201 q 19 q 18 q 17 q 16
q Long
q 201 q 19 q 18 q 17 q 16 q 15 q 14
q 211 q 201 q 19 q 18 q 17 q 16 q 15
q 222 q 211 q 201 q 19 q 18 q 17 q 16
q 222 q 211 q 201 q 19 q 18 q 17
q 222 q 211 q 201 q 19 q 18
1 Price is $605 E2203 2 Price is $1025 E2204
A
Select Frame Depth within desired Frame Depth Range
Frame DepthRange
Frame Depth
q Short14” - 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 $605
E2203
q Long18” - 22”
q 18 q 19 q 20 q 21 q 22
N/C N/C $605 $605 $1025
E2203 E2203 E2204
Make one selection from either Option 1 at right or Option 2 below based on desired seating setup
Back CanesBack Canes
Front of ChairFront of Chair
4” Forward4” Forward
2” Forward2” Forward
FlushFlush
2” Rearward2” Rearward
Select Frame Width within desired Frame Width Range
Frame WidthRange
Frame 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
Phone (800) 981-1540 | Fax (715) [email protected] | www.kimobility.com
DCN0049.25 Pricing and specifications subject to change without notice Page 1 of 7
A
q Frame Width Range / Frame Width
q OPTION 1: Setup By Ki Mobility
q OPTION 2: Setup By Frame Depth
This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows.
Seat Pan
q Growing Adjustable Aluminum Seat Pan E2231 _____________________ $200q Omit Seat Pan _____________________________________________________________________________________ N/C
q Focus CRe - Transit Included E1161 _______________________ $3095300 lb weight capacity. Price does not include one time free growth kit. Tilt range: -5º anterior to 50º posterior.
q Focus CRe - Transit Not Included E1161 _____________ $2775300 lb weight capacity. Price does not include one time free growth kit. Tilt range: -5º anterior to 50º posterior.
Effective 08/19/2020
Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________
Frame Options
Tilt Mechanism
Hand
q Hand Tilt - Right _________________________________________________________________________________ N/Cq Hand Tilt - Left ____________________________________________________________________________________ N/Cq Hand Tilt - Dual __________________________________________________________________________________ N/C
Backrest
Reclining Backrest OptionsSelect options below if Reclining Back is selected
Recline Angle: q 0º - 65º E1225
q 10º - 75º E1225
q 20º - 85º E1226
Gas Spring: q Standard Spring q Heavy Duty Spring
Stroller Handle Back Post OptionAvailable only with Stroller Handle Back Post
q Removable Stroller Handle Extension _________________________________________ $90
Other Backrest Options
q Non Folding Back ______________________________________________________________________________ N/CStandard with Reclining Back and Seating Dynamics Rocker Back
q Seating Dynamics Rocker Back K0108 __________________________________ $1995Available only with Non Folding Back. Not available with Angle Adjustable Locking Extendable Flip Up Armrest or 400 lb Weight Capacity.
q Adjustable Height Rigidizer Bar _____________________________________________________ $75
Vent and Battery TrayRequires minimum 16” Seat Height. Available on 14” or 15” Frame Widths with hand tilt only. Not available with Attendant Foot Lock, 12” wheels, One Arm Drive, 5” casters or Power Tilt.
q Vent Tray E1029 _________________________________________________________________________________ $250Not available with Self Propel Axle Plate. Requires Anti-Tip
q Battery Box Holder E1029 _____________________________________________________________ $250Available only with Dual Hand Tilt
q Vent Tray and Battery Box Holder E1029 __________________________________ $500Requires Anti-Tip. Available only with Dual Hand Tilt. Not available with Self Propel Axle Plate.
Foot
q Foot Tilt - Right ___________________________________________________________________________________ N/Cq Foot Tilt - Left ______________________________________________________________________________________ N/C
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0049.25 Pricing and specifications subject to change without notice Page 2 of 7
Power TiltNot available with Vent Tray, Battery Box Holder or 400 lb Weight Capacity. Includes anterior and posterior tilt stops.
q Power Tilt - Right K0108 ______________________________________________________________ $2195q Power Tilt - Left K0108 _________________________________________________________________ $2195
Power Tilt OptionsPower Tilt selection required
q Toggle Switch ________________________________________________________________________________________ Stdq Pendant Control K0108 ____________________________________________________________________ N/C
Sent as accessoryq Interface for Adaptive Switching K0108 ____________________________________ $275
Sent as accessory
Offset Hanger Option
q Offset Hanger ______________________________________________________________________________________ $30Tilt Stop included. No anterior tilt.
Weight Capacity
q 300 lb Weight Capacity ____________________________________________________________________ N/Cq 400 lb Weight Capacity (Heavy Duty) ________________________________________ $425
Available only with Long Frame Depth Range and 8” x 2” or 6” x 2” Casters
Transit Option
q Transit System _________________________________________________________________________________ $320q Omit Transit __________________________________________________________________________________________ N/C
Back PostStroller Handle Back Post (Folding)
q Short 20” ___________________________________________________________________________________ N/Cq Tall 24” ________________________________________________________________________________________ N/C
Fixed Height with Adjustable Handle (Folding)Not available with Seating Dynamics Rocker Back
q Short 22” ___________________________________________________________________________________ N/Cq Tall 26” ________________________________________________________________________________________ N/C
Adjustable Height with Adjustable Handle (Folding)q Short 18”-25” ___________________________________________________________________________ $25
Not available with O2 Holder or Seating Dynamics Rocker Back
q 18” q 19” q 20” q 21” q 22” q 23” q 24” q 25”
q Tall 20”-27” _______________________________________________________________________________ $2520”-22” Heights not available with Seating Dynamics Rocker Back
q 20” q 21” q 22” q 23” q 24” q 25” q 26” q 27”
Reclining Back with Adjustable Handle (Non-Folding)Not available with O2 Holder or Seating Dynamics Rocker Back
q Short 22” ______________________________________________________________________________ $1000q Tall 26” ___________________________________________________________________________________ $1000
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Footrest
Footrest / Extension / Seat to Footrest LengthSelect Seat to Footrest Length in row corresponding to desired Footrest and Extension. Footrest Length of at least 2.5” shorter than Front Seat Height recommended. Extension Tube Hanger measurements 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
Contracture Footrest
q Short q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5
q Medium q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5
q Long q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5
Peds 2
PRO ELR
q Low Pivot q 7 3 q 7.5 3 q 8 3 q 8.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5
q High Pivot q 5.5 3 q 6 3 q 6.5 3 q 7 q 7.5 q 8 q 8.5 q 9 q 9.5 q 10
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 Front Seat Height chart below2 Comes standard with 3” Extension3 Not available on chairs 15” wide or more
Minimum Front Seat Height with Front Mount Hangers
Hanger Length Short Medium Long
Hanger Bend 70º 80/90º 70º 80/90º 70º 80º
Minimum Front Seat Height with Standard Selection
13” 13” 13” 13.5” 14.5” 15.5”
Minimum Front 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
DCN0049.25 Pricing and specifications subject to change without notice Page 3 of 7
Bilateral Mount Center Mount
Hanger 60º 70º 80º 90º Retail
Extension Tube Mount q q q1 N/C
Front Mount q q1 q2 N/CPediatric Pro Elevating Leg Rests (Peds PRO ELR) E0990 q $295
Pro Elevating Leg Rests (PRO ELR) E0990 q $295
Contracture Footrest3
Bilateral Mount K0108q $350
Contracture Footrest3
Center Mount K0108q $350
Omit Hangers q -$201 7” or 8” Casters may interfere with less than 5º tilt2 Not avaliable with 7” or 8” Casters3 Aluminum Angle Adjustable footplates included. See image to right.
Hanger / Front Frame Bend
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0049.25 Pricing and specifications subject to change without notice Page 4 of 7
Hanger ReleaseNo selection needed with Contracture Footrest. If no selection is made 4-Way - In line Hanger Release will be used.
q Classic ___________________________________________________________________________________________________ N/Cq 4-Way - In line ______________________________________________________________________________________ Std
See reference A below. Not available with PRO ELR or Peds PRO ELR.
q 4-Way - Out _________________________________________________________________________________________ N/CSee reference B below. Not available with PRO ELR or Peds PRO ELR.
A B
Residual Limb Support
Heel Loop
Calf Strap
q Velcro Adjustable K0038 ___________________________________________________________________ $40q Padded Velcro Adjustable K0038 __________________________________________________ $68q Bodypoint Padded AeroMesh K0038 _________________________________________ $102
Not available with One Piece Flip Up Angle Adjustable Footplate
q Heel Loops E0951 ______________________________________________________________________________ $40q Adjustable Heel Loops E0951 ________________________________________________________ $50q Omit Heel Loops ________________________________________________________________________________ N/C
Footrest continued
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
FootplateNo selection needed with Contracture Footrest
q Composite ____________________________________________________________________________________________ N/CNot available with Front Mount Hanger or PRO ELR
q Composite Angle Adjustable K0040 ___________________________________________ $185Not available with Front Mount Hanger or 14” Seat Width without Offset Hanger
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, PRO ELR or 21” or 22” Seat Widths in combination with Offset Hanger
Select Seat Height corresponding to desired Rear Wheel and Caster Size
Seat Height, Casters and Rear Wheels
Seat Height / Caster Size / Rear Wheel Size
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0049.25 Pricing and specifications subject to change without notice Page 5 of 7
RearWheelSize
Caster Size
5” 6” 6” x 2” 7” 8” 8” x 2”
Seat Height
12” 3
withPneumaticorPneumatic withAirlessInsertTire
q 13.5
q 14
q 14.5 q 14.5 q 14.5 q 17 6
q 17.5 q 17.5 q 17.5 q 17.5 q 17.5 q 17.5
q 18 q 18 q 18 q 18 q 18 q 18
q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5
q 19 q 19 q 19 q 19 q 19 q 19
q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5
12” 3
withFullPolyTire
q 16.5 q 16.5 q 16.5 q 16.5 5
q 17 q 17 q 17 q 17 q 17 q 17
q 17.5 q 17.5 q 17.5 q 17.5 q 17.5 q 17.5
q 18 q 18 q 18 q 18 q 18 q 18
q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5
q 19 q 19 q 19 q 19 q 19 5
16” 4
withPneumatic, Pneumatic with AirlessInsert or Full PolyTire
q 13
q 13.5
q 14 q 14 q 14
q 14.5 q 14.5 q 14.5
q 15 q 15 q 15 q 15
q 15.5 q 15.5 q 15.5 q 15.5 q 15.5 5
q 16 q 16 q 16 q 16 q 16 q 16
q 16.5 1 q 16.5 q 16.5 1 q 16.5 1 q 16.5 1
q 19 q 19 q 19 q 19 2 q 19 q 19
q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5
q 20 q 20 q 20 q 20 q 20 q 20
q 20.5 q 20.5 q 20.5 q 20.5 q 20.5 q 20.5
16” 4
withLow PolyTire
q 13
q 13.5
q 14 q 14 q 14
q 14.5 q 14.5 q 14.5
q 15 q 15 q 15 q 15
q 18 q 18 q 18 q 18 q 18 q 18
q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5
q 19 q 19 q 19 q 19 q 19 q 19
q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5
q 20 q 20 q 20 q 20 q 20 q 20
q 20.5 q 20.5 q 20.5 6
RearWheelSize
Caster Size
5” 6” 6” x 2” 7” 8” 8” x 2”
Seat Height
16” 4
withDrum Brake
q 13.5
q 14 q 14 q 14
q 14.5 q 14.5 q 14.5
q 15 q 15 q 15 q 15
q 15.5 q 15.5 q 15.5 q 15.5
q 16 q 16 q 16 q 18 5 q 16
q 18.5 q 18.5 q 18.5 q 18.5 q 18.5
q 19 q 19 q 19 q 19 q 19 q 19
q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5
q 20 q 20 q 20 q 20 q 20 q 20
q 20.5 q 20.5 q 20.5 q 20.5 q 20.5 q 20.5
20”
q 15 q 15 q 15 q 15
q 15.5 q 15.5 q 15.5 q 15.5 q 15.5 5
q 16 q 16 q 16 q 16 q 16 q 16
q 16.5 q 16.5 q 16.5 q 16.5 q 16.5 q 16.5
q 17 q 17 q 17 q 17 q 17 q 17
q 17.5 q 17.5 q 17.5 q 17.5 q 17.5 q 17.5
q 18 q 18 q 18 q 18 q 18 q 18
q 18.5 2 q 18.5 2 q 18.5 2 q 18.5 2 q 18.52,5
22”
q 16 q 16 q 16 q 16 q 16
q 16.5 q 16.5 q 16.5 q 16.5 q 16.5 q 16.5
q 17 q 17 q 17 q 17 q 17 q 17
q 17.5 q 17.5 q 17.5 q 17.5 q 17.5 q 17.5
q 18 q 18 q 18 q 18 q 18 q 18
q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5
q 19 q 19 q 19 q 19 q 19 q 19
q 19.5 q 19.5 q 19.5 q 19.5 q 19.5
24”
q 16.5 q 16.5 1 q 16.5 1 q16.51,5,7
q 17 q 17 q 17 q 17 q 17 q 17
q 17.5 q 17.5 q 17.5 q 17.5 q 17.5 q 17.5
q 18 q 18 q 18 q 18 q 18 q 18
q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5
q 19 q 19 q 19 q 19 q 19 q 19
q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5
q 20 q 20 q 20 q 20 q 20 q 20 2
1 Available only with Full Poly tire2 Not available with Full Poly tire3 Not available with Vent and Battery Tray combination4 Seat heights higher than 16.5” with 16” wheel size are not available with Vent and Battery Tray combination5 Available only with 1.5” Poly casters6 Not available with 1.5” Poly casters7 Not available with spoke wheel
Rear Tire Type
q Full Poly E2218 _____________________________________________________________________________________ N/Cq Low Poly E2218 ___________________________________________________________________________________ N/C
Available only with 16” wheel size
q Pneumatic E2211, E2212 ____________________________________________________________________ N/Cq Pneumatic with Airless Insert E2211, E2213 _________________________________ $85
Handrim OptionNot available on Plastic Coated or Projection Handrims
q 3M Micro Grip _____________________________________________________________________________________ $65
Axle
Wheel Locks
Casters and Rear Wheels
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Handrim
q Aluminum Anodized ___________________________________________________________________________ Stdq Plastic Coated ___________________________________________________________________________________ $115q Projection (8 Vertical Projections) ________________________________________________ $295
Available only with full profile tires in combination with 24” wheel sizes
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
Handrims not available on 12” or 16” wheel sizes. No selection needed with One Arm DriveStandard Handrims
One Arm Drive
q One Arm Drive E0958 ___________________________________________________________________ $1295Available only with 20”-24” Mag wheels. Not available with Vent Tray, Battery Box Holder, Self Propel Axle Plate or Angle Adjustable Locking Extendable Flip Up. Standard Handrim will be Aluminum Anodized. Axle not quick release.
Drive Handrim Side: q Left q Right
Drive Handrim Type: q Aluminum _______________________________________ N/C q Poly Coated _________________________________ $200
q Self Propel Axle Plate _______________________________________________________________________ $95Not available with Vent Tray or 12” or 16” wheel sizes
Self Propel Axle Plate
No selection needed with One Arm Drive or Drum Brake
q Fixed ______________________________________________________________________________________________________ N/Cq Quick Release _____________________________________________________________________________________ N/C
Wheel Lock
q Push to Lock ________________________________________________________________________________________ Stdq Pull to Lock __________________________________________________________________________________________ N/C
Not available with 12” or 16” Full Poly tires
q Attendant Foot Lock _________________________________________________________________________ $75q Drum Brake E2228 _______________________________________________________________________ $1200
Not available with Hand Tilt Mechanism, Reclining Backrest, Stroller Handle Extension or 16” Low Poly tire. Axle is Quick Release.
q Omit Wheel Locks _____________________________________________________________________________ N/C
q Extension Handles E0961 ________________________________________________________________ $70Available only with Push to Lock or Pull to Lock Wheel Locks.
Wheel Lock Options
Wheel Lock continued
q Combination Attendant Foot Lock _____________________________________________ $145Available only with 12” or 16” wheel sizes. Includes Extension Handles. Push to Lock only.
Dual - Drum Brake ______________________________________________________________________________ $1270Not available with Hand Tilt Mechanism, Reclining Backrest, Stroller Handle Extension or 16” Low Poly tire. Axle is Quick Release.
q Push to Lock q Pull to Lock
DCN0049.25 Pricing and specifications subject to change without notice Page 6 of 7
Caster SizePrice 5” 6” 7” 8”
Cas
ter
Typ
e
1” Poly N/C q q q q1” Poly Aluminum $110 q1” Pneumatic $110 q q1.5” Poly $85 q q q1.5” Soft Roll Aluminum $175 q q2” Poly $90 q2” Pneumatic w/ Foam Insert $225 q
Caster
Rear Wheel SizePrice 12” 16” 20” 22” 24”
Rea
r W
heel
Ty
pe
Mag N/C q q q q q
MAXX Performance Spoke $200 q
Rear Wheel
Removable Side Guard
q Composite Side Guards K0108 ____________________________________________________ $140Not available with T-Arm or Dual Post Flip Back Armrests
Accessories
Anti-Tip
q Rear Anti-Tips E0971 _______________________________________________________________________ $150Required with Reclining Backrest or Vent Tray
q Omit Rear Anti-Tips ___________________________________________________________________________ N/C
Frame Color
Matte FinishGloss Finish
q Charcoal Gray _____________________________________________________________________________________ N/Cq Emerald Green ____________________________________________________________________________________ N/Cq Iridescent Burgundy __________________________________________________________________________ N/Cq Iridescent Navy ___________________________________________________________________________________ N/Cq Military Green ______________________________________________________________________________________ N/Cq Retro Red _____________________________________________________________________________________________ N/Cq Royal Blue ____________________________________________________________________________________________ N/Cq Shadow Black _____________________________________________________________________________________ N/Cq Smooth White _____________________________________________________________________________________ N/C
q Black ______________________________________________________________________________________________________ N/Cq Blue Skies ____________________________________________________________________________________________ N/Cq Bubblegum Pink _________________________________________________________________________________ N/Cq Candy Blue __________________________________________________________________________________________ N/Cq Candy Purple ______________________________________________________________________________________ N/Cq Candy Red ___________________________________________________________________________________________ N/Cq Copper __________________________________________________________________________________________________ N/Cq Granny Smith ______________________________________________________________________________________ N/Cq Metallic Orange __________________________________________________________________________________ N/Cq Yellow ____________________________________________________________________________________________________ N/C
Positioning Belt
q 1 1/2” Auto Buckle E0978 ________________________________________________________________ $70q 1 1/2” Padded Auto Buckle E0978 _____________________________________________ $155q 2” Airline Buckle E0978 ___________________________________________________________________ $110
Bodypoint Evoflex - Pelvic Stabilizer E0978 ____________________________________ $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
Available only with spoke wheel
q Black Spoke Guards K0065 __________________________________________________________ $115Available only with spoke wheel
q Tilt Stop (Pair) K0108 _________________________________________________________________________ $30Included with Offset Hanger
q IV Pole _________________________________________________________________________________________________ $275q Canopy with Hardware K0108 ______________________________________________________ $280
See image belowBelt Mounting Kit
q Ki Mobility Belt Mounting Brackets ______________________________________________ $50q Bodypoint 1” Band Clamp Belt Mounting Kit _________________________ $105
O2 Holder
q O2 Holder E2208 _______________________________________________________________________________ $170Not available with Reclining Backrest or Seating Dynamics Rocker Back
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0049.25 Pricing and specifications subject to change without noticePage 7 of 7
Armrests
Military Patch Canopy Height Above Hardware
14”
Hardware mounts on vertical part of back cane.
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
ArmrestHeight Adjustable T-Arm (8.5” - 13.5”) E0973
Not available with 400 lb Weight Capacity
q Desk _______________________________________ $285 q Full ________________________________________ $285Height Adjustable T-Arm Low (7.5” - 11.5”) E0973
Not available with 400 lb Weight Capacity
q Desk _______________________________________ $285 q Full ________________________________________ $285Height Adjustable Dual Post Flip Back (9.5”-14.5”) E0973
Not available with IV Pole
q Desk _______________________________________ $295 q Full ________________________________________ $295
Angle Adjustable Locking Extendable Flip Up E0973Not available with Seating Dynamics Rocker Back or 400 lb Weight Capacity. Minimum armrest height with Reclining Back is 12”.
q Desk _______________________________________________________________________________________ $265 q Full ___________________________________________________________________________________________ $265q Omit Armrests _____________________________________________________________________________________ N/C
Arm Pad
q Standard Arm Pad _____________________________________________________________________________ N/Cq Waterfall Arm Pad ______________________________________________________________________________ $25
Not available with Angle Adjustable Locking Extendable Flip Up Armrest
q Foam Grip ____________________________________________________________________________________________ N/CAvailable only with Angle Adjustable Locking Extendable Flip Up Armrest
DCN0537.1 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
[email protected] | www.kimobility.com
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
Retail $210 $85 $210 $85 $210 $85 $210 $85 $210 $85 $210 $85 $210 $85 $315 $85HCPC E2603 E2603 E2603 E2603 E2603 E2603 E2603 E2604
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
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
Retail $355 $95 $355 $95 $355 $95 $355 $95 $355 $95 $355 $95 $355 $95 $460 $95HCPC E2605 E2605 E2605 E2605 E2605 E2605 E2605 E2606
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
Weight capacity: 350 lbs
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0537.1 Pricing and specifications subject to change without notice Page 2 of 2
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 $430 $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 $470 $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
DCN0538.2 Pricing and specifications subject to change without notice Page 1 of 5
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Axiom Back Select back that is the same or up to 2” narrower than the width of the frame. Hardware is included with back. Low Back selections are not available with headrests, modifications, or posture supports. Weight capacity: 300 lbs.
Width
12” 14” 16” 18” 20” 22”Retail $555 $555 $555 $555 $555 $791
HCPC E2613 E2613 E2613 E2613 E2613 E2614
Hei
gh
t Lo
w
8” q AXPB1208 q AXPB1408 q AXPB1608 q AXPB1808 q AXPB2008
10” q AXPB1410 q AXPB1610 q AXPB1810 q AXPB2010 q AXPB2210
12” q AXPB1212 q AXPB1412 q AXPB1612 q AXPB1812 q AXPB2012
Mid
14” q AXPB1414 q AXPB1614 q AXPB1814 q AXPB2014 q AXPB2214
16” q AXPB1216 q AXPB1416 q AXPB1616 q AXPB1816 q AXPB2016
18” q AXPB1418 q AXPB1618 q AXPB1818 q AXPB2018 q AXPB2218
Axiom Posterior Back (PB)
Width
12” 14” 16” 18” 20” 22”Retail $636 $636 $636 $636 $636 $862
HCPC E2615 E2615 E2615 E2615 E2615 E2616
Hei
gh
t
Lo
w
8” q AXPL1208 q AXPL1408 q AXPL1608 q AXPL1808 q AXPL2008
10” q AXPL1410 q AXPL1610 q AXPL1810 q AXPL2010 q AXPL2210
12” q AXPL1212 q AXPL1412 q AXPL1612 q AXPL1812 q AXPL2012
Mid
14” q AXPL1414 q AXPL1614 q AXPL1814 q AXPL2014 q AXPL2214
16” q AXPL1216 q AXPL1416 q AXPL1616 q AXPL1816 q AXPL2016
18” q AXPL1418 q AXPL1618 q AXPL1818 q AXPL2018 q AXPL2218
Tall 20” q AXPL1220 q AXPL1420 q AXPL1620 q AXPL1820 q AXPL2020
22” q AXPL1422 q AXPL1622 q AXPL1822 q AXPL2022 q AXPL2222
Axiom Posterior Lateral Back (PL)
Axiom Posterior Back - Low Axiom Posterior Back - Mid
Axiom Posterior Back Measurement Reference
Back Height A B Shell Contour Depth
Hei
gh
t Lo
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
Back Height A B Shell Contour Depth
Hei
gh
t
Lo
w
8” 10” 6.5”
3.65”
10” 12” 8.5”
12” 14” 10.5”
Mid
14” 16” 8.5”
16” 18” 9.5”
18” 20” 10.5”
Tall 20” 22” 11.5”
22” 24” 12.5”Axiom Posterior Lateral
Back - LowAxiom Posterior Lateral
Back - MidAxiom Posterior Lateral
Back - Tall
A
5.5
B
5.5
AB
A
5.5
B
DCN0538.2 Pricing and specifications subject to change without notice Page 2 of 5
Width
12” 14” 16” 18” 20” 22”Retail $735 $735 $735 $735 $735 $813
HCPC E2620 E2620 E2620 E2620 E2620 E2621
Hei
gh
t
Lo
w
8” q AXLB1208 q AXLB1408 q AXLB1608 q AXLB1808 q AXLB2008
10” q AXLB1410 q AXLB1610 q AXLB1810 q AXLB2010 q AXLB2210
12” q AXLB1212 q AXLB1412 q AXLB1612 q AXLB1812 q AXLB2012
Mid
14” q AXLB1414 q AXLB1614 q AXLB1814 q AXLB2014 q AXLB2214
16” q AXLB1216 q AXLB1416 q AXLB1616 q AXLB1816 q AXLB2016
18” q AXLB1418 q AXLB1618 q AXLB1818 q AXLB2018 q AXLB2218
Tall 20” q AXLB1220 q AXLB1420 q AXLB1620 q AXLB1820 q AXLB2020
22” q AXLB1422 q AXLB1622 q AXLB1822 q AXLB2022 q AXLB2222
Axiom Lateral Back (LB)
Axiom Back continued Select back that is the same or up to 2” narrower than the width of the frame. Hardware is included with back. Low Back selections are not available with headrests, modifications, or posture supports. Weight capacity: 300 lbs.
Axiom Lateral Back Measurement Reference
Back Height A B Shell Contour Depth
Hei
gh
t
Lo
w
8” 10” 6.5”
3.65”
10” 12” 8.5”
12” 14” 10.5”
Mid
14” 16” 8.5”
16” 18” 9.5”
18” 20” 10.5”
Tall 20” 22” 11.5”
22” 24” 12.5”Axiom Lateral
Back - LowAxiom Lateral
Back - MidAxiom Lateral
Back - Tall
A
5.5
B
5.5
AB
A
5.5
B
Axiom Deep Lateral Back (DL)
Width
12” 14” 16” 18” 20” 22”Retail $735 $735 $735 $735 $735 $813
HCPC E2620 E2620 E2620 E2620 E2620 E2621
Hei
gh
t
Mid
14” q AXDL1214 q AXDL1414 q AXDL1614 q AXDL1814 q AXDL2014 q AXDL2214
16” q AXDL1416 q AXDL1616 q AXDL1816 q AXDL2016
18” q AXDL1218 q AXDL1418 q AXDL1618 q AXDL1818 q AXDL2018 q AXDL2218
Tall 20” q AXDL1220 q AXDL1420 q AXDL1620 q AXDL1820 q AXDL2020
22” q AXDL1422 q AXDL1622 q AXDL1822 q AXDL2022 q AXDL2222
Axiom Deep Lateral Back Measurement Reference
Back Height A
B1 Shell Contour Depth12” 14” 16” 18” 20” 22”
Hei
gh
t
Mid
14” 16” 8.25” 8.25” 8.25” 8.25” 8.25” 8.25”
6”
16” 18” 9.25” 9.25” 9.25” 9.25” 9.25” 9.25”
18” 20” 10.25” 10.25” 10.25” 10.25” 10.25” 10.25”
Tall 20” 22” 9.5” 9.75” 10” 10.25” 10.25” 10.5”
22” 24” 10.75” 11” 11.25” 11.5” 11.5” 11.75”1 Measurement based on back width
Axiom Deep Lateral Back - Mid Axiom Deep Lateral Back - Tall
AB
7.75
AB
7.75
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Description Item Code HCPC Retail (Each)
q Headrest Flip Down MountOnly available with HEDHMD401/HEDHMD417
HDR100 E1028 $170
q Universal Mounting PlateFor use with other manufacturer headrests
UMP K0108 $40
DCN0538.2 Pricing and specifications subject to change without notice Page 3 of 5
Axiom Back Accessories
Headrest and HardwareChoose headrest and hardware combination in chart below. Not available with Low Backs.
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
HEDHDW101/HEDHDW117 HEDHDW201/HEDHDW217 HEDHDW401/HEDHDW417
HEDPAD408
HEDPAD410
HEDPAD414
HEDPAD201
HEDPAD202
HEDPAD203
HEDPAD502
HEDPAD503
Hardware
Standard Straight Back Mount Hardware with Ball
Multi Axis Removable Hardware with Horizontal Bar
Headrest Hardware with Ball
HEDHDW101 / HEDHDW117 HEDHDW201 / HEDHDW217 HEDHDW401 / HEDHDW417
Description Item Code HCPC Kio Code Retail Kio Code Retail Kio Code Retail
Hea
dre
st P
ad
Comfort Plus Headrest 8” HEDPAD408 E0955E1028 q HDR001 $277 q HDR009 $313 q HDR017 $388
Comfort Plus Headrest 10” HEDPAD410 E0955E1028 q HDR002 $277 q HDR010 $313 q HDR018 $388
Comfort Plus Headrest 14” HEDPAD414 E0955E1028 q HDR003 $277 q HDR011 $313 q HDR019 $388
Small All Positioning Headrest Pad and Ring Only HEDPAD201 E0955
E1028 q HDR004 $277 q HDR012 $313 q HDR020 $388
Medium All Positioning Headrest Pad and Ring Only
HEDPAD202 E0955E1028 q HDR005 $277 q HDR013 $313 q HDR021 $388
Large All Positioning Headrest Pad and Ring Only HEDPAD203 E0955
E1028 q HDR006 $277 q HDR014 $313 q HDR022 $388
Tri-Comfort Plus Headrest 14”
HEDPAD502 E0955E1028 q HDR007 $288 q HDR015 $324 q HDR023 $399
Tri-Comfort Plus Headrest 19”
HEDPAD503 E0955E1028 q HDR008 $288 q HDR016 $324 q HDR024 $399
Headrest Hardware Options
DCN0538.2 Pricing and specifications subject to change without notice Page 4 of 5
Axiom Back Accessories continued
Available only with Axiom Lateral Back and Axiom Deep Lateral back
Description Item Code HCPC Retail
q Lumbar Pad 12” L12 K0108 $48
q Lumbar Pad 14” L14 K0108 $48
q Lumbar Pad 16” L16 K0108 $48
q Lumbar Pad 18” L18 K0108 $48
q Lumbar Pad 20” L20 K0108 $48
q Lumbar Pad 22” L22 K0108 $48
Lumbar Pads
Description Item Code HCPC Retail
q Privacy Flap 12” PF12 K0108 $45
q Privacy Flap 14” PF14 K0108 $45
q Privacy Flap 16” PF16 K0108 $45
q Privacy Flap 18” PF18 K0108 $45
q Privacy Flap 20” PF20 K0108 $45
q Privacy Flap 22” PF22 K0108 $45
Privacy Flap
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Lateral Support
Laterals for Posterior BackPair Left Right Description Item Code HCPC Pair Each
q q q 3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF3x4P E0956 $305 $153
q q q 4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF4x5P E0956 $305 $153
q q q 3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back LS3x4P E0956, E1028 $650 $325
q q q 4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back LS4x5P E0956, E1028 $650 $325Laterals for Posterior Lateral BackPair Left Right Description Item Code HCPC Pair Each
q q q 3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral Back LF3x4L E0956 $305 $153
q q q 4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral Back LF4x5L E0956 $305 $153
q q q3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral Back
LS3x4L E0956, E1028 $650 $325
q q q4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral Back
LS4x5L E0956, E1028 $650 $325
DCN0538.2 Pricing and specifications subject to change without notice Page 5 of 5
Axiom Back Accessories continued
Selection of a modification from the Axiom Back Modifications section required in order to mount posture supports. Not available with Low Backs.
Description Item Code HCPC Retail
q Small Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60153T E0960 $144
q Medium Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60154T E0960 $144
q Large Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60155T E0960 $144
q Small Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60110T E0960 $113
q Medium Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60111T E0960 $113
q Large Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60112T E0960 $113
q Small Dynamic Therafit Comfortfit Full Vest 30589T E0960 $167
q Medum Dynamic Therafit Comfortfit Full Vest 30590T E0960 $167
q Large Dynamic Therafit Comfortfit Full Vest 30591T E0960 $167
q XLarge Dynamic Therafit Comfortfit Full Vest 30592T E0960 $167
q XXLarge Dynamic Therafit Comfortfit Full Vest 30593T E0960 $167
q Small Dynamic Therafit Comfortfit Trim Vest 30618T E0960 $169
q Medum Dynamic Therafit Comfortfit Trim Vest 30619T E0960 $169
q Large Dynamic Therafit Comfortfit Trim Vest 30620T E0960 $169
q XLarge Dynamic Therafit Comfortfit Trim Vest 30621T E0960 $169
q XXLarge Dynamic Therafit Comfortfit Trim Vest 30622T E0960 $169
Therafin Posture Support
Choose modification to add holes to the back shell in order to mount posture supports. Not available with Low Backs.
Description Item Code HCPC Retail
q Modification for 4 Point Harness AXM4PT K0108 N/C
q Modification for 2 Point Chest Strap AXM2PT K0108 N/C
q Modification for Shoulder GuidesIncludes shoulder guides
AXMSG K0108 $50
Axiom Back Modifications
Gloss Finish Item Code Retail
q Black AXMBLK N/C
q Blue Skies AXMSKY N/C
q Bubblegum Pink AXMPNK N/C
q Candy Blue AXMCBL N/C
q Candy Purple AXMPUR N/C
q Candy Red AXMRED N/C
q Copper AXMCOP N/C
q Granny Smith AXMGSM N/C
q Metallic Orange AXMMOR N/C
q Silver AXMSIL N/C
q Teal AXMTEA N/C
q Yellow AXMYLW N/C
Painted Back Shell ModificationIf no selection is made, standard Shadow Black will be used with no additional lead time
Axiom Back Modifications Extended lead times will apply for all modifications
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Matte Finish Item Code Retail
q Charcoal Gray AXMCGM N/C
q Emerald Green AXMEGM N/C
q Iridescent Burgundy AXMIBM N/C
q Iridescent Navy AXMINM N/C
q Military Green AXMAGM N/C
q Retro Red AXMRRM N/C
q Royal Blue AXMRBM N/C
q Smooth White AXMSWM N/C