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Page 1 of 11INFINFB3975/RevB/06MAY2019
Quantum 1450 Order Form with TRU-Balance® Bariatric Tilt
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. Options noted with "XRef" have multiple possible part numbers based on system configuration. Please see cross-reference spreadsheet for the XRef part numbers.
Thank you for choosing Quantum!
INTRODUCTION
PATIENT INFORMATION
1. BASE MODELREQUIRED. Select a group 3 power base. 600 lb. weight capacity with standard 14" flat free tires, 4.5 mph motors, and 8 amp off board charger. Dimensions of base without legrests: 29.25”W x 38.25”L.
Quantum 1450 3SPVHD-SS ...........................................................................................................................................$11,095Part: Q1450 3SPVHD-SS. HCPCS: K0860Single power option.
Page 2 of 11INFINFB3975/RevB/06MAY2019
1. Q-Logic 2 Required ComponentsQ-Logic 2 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 2 Joystick
3. Q-Logic 2 Joystick ArmorREQUIRED with Q-Logic 2 EX Joystick selection above. Reference colors shown in section 2.
Stand Alone Joystick
Q-Logic 2 EXController Module
4.1b. 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.
Black, Soft Touch ....................................StandardPart: DGN124307
Non-matching Joystick Armor .......................... $50Part: PTOINDV3422Select color below
Match Joystick Armor to Base Color ................... $50Part: PTOINDV3421
Red CorvettePart: DGN124336-PRD1
Electric BluePart: DGN124336-PBU9
Back in BlackPart: DGN124336-PBK1
White SatinPart: DGN124336-PWH2
Pretty in PinkPart: DGN124336-PPK3
Deep PurplePart: DGN124336-PPR5
Lime LightPart: DGN124336-PGN7
Grey StreetPart: DGN124336-PSL3
Silver BulletPart: DGN124336-PSL7
Midnight BluePart: DGN124336-PBU10
Orange CrushPart: DGN124336-POR6
Yellow BlazePart: DGN124336-PYL3
Q-Logic 2 EX Controller Module .......................$695Tilt thru toggle part: ELE136029. Tilt thru joystick part: ELE136030. HCPCS: E2377
Q-Logic 2 Expandable Controller Harness ...........$425Part: DWR1111H065. HCPCS: E2313
Q-Logic 2 EX Joystick ....................................$700Part: CTL123217
Q-Logic 2 EX Joystick for Full Lights .................$700Part: CTL124653
No Joystick, Setup for Q-LogicPart: Configuration selection.
Stand Alone Joystick with ..............................$700External Charger PortPart: ELEASMB5205Up to 3 drive profiles and 1 seating profile when used alone. Use in conjunction with Enhanced Display for up to 5 profiles and auxiliary functions such as Bluetooth Mouse and IR. Includes charger port mounting bracket and multiplier box harness.
Heavy Duty, 17"Wx13"D, Foot Platform ......................... StandardPart: FRMASMB17955
Heavy Duty, 17"Wx16"D, Foot Platform ....................... No ChargePart: FRMASMB17956
Omit Base Mounted Foot Platform ............................. No ChargePart: PTOINDV3674
VR2 6-Key Joystick .................................................. StandardPart: CTLDC1498
No Joystick, Setup for VR2 Joystick ........................... No ChargePart: Configuration selection
2. BASE COLORREQUIRED. Select one shroud color. Colors shown here may differ from actual product depending on monitor/printer calibration used.
3. BASE MOUNTED FOOT PLATFORMREQUIRED. Select a foot platform option. May interfere with seat mounted legrests.
Account Number: ___________ Date: ________________ Marked for: _____________________________________
4. 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.
4.1a. Non-Expandable ControlsSelect a joystick below or omit selection if another controller type is desired. Non-expandable does not allow supplementary drive controllers.
Candy Apple RedPart: SHDASMB6684
Viper BluePart: SHDASMB6685
Onyx BlackPart: SHDASMB6686
Sunburst OrangePart: SHDASMB6688
Pearl PinkPart: SHDASMB6695
SilverPart: SHDASMB6689
Emerald GreenPart: SHDASMB6699
Sapphire Blue Part: SHDASMB6701
Orion YellowPart: SHDASMB7110017
True BluePart: SHDASMB7110018
To Be DeterminedPart: N/A
Q-Logic 2 EX Joystick
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
Joystick Handles
5. JOYSTICK HANDLESREQUIRED. The Q-Logic 2 EX joysticks are standard with a carrot handle (See A in image). The optional handle will be mounted to the joystick and the standard handle will be shipped with the unit.
Page 3 of 11INFINFB3975/RevB/06MAY2019
6.1b. Swing-Away (Retractable) Joystick BracketAllows the joystick to retract to the side of the armrest while maintaining the same joystick orientation. "Inline bracket" is used with track/TRU-Balance 3 style arms (not on this order form) when the joystick is inline with armpad. "Inline bracket" will be offset 1" when used with tube style arms. Select "Offset Bracket" to have the joystick inline with armpad on tube style armrests.
Swing-away, Inline, Left Side Mount ..................$245VR2 Part: ACC142529. Q-Logic: ACC142524. HCPCS: E1028
Swing-away, Inline, Right Side Mount ................$245VR2 Part: ACC142530. Q-Logic: ACC142525. HCPCS: E1028
Swing-away, 1” Offset, Left Side Mount .............$245VR2 Part: ACC142749. Q-Logic: ACC142742. HCPCS: E1028
Swing-away, 1” Offset, Right Side Mount ............$245VR2 Part: ACC142750. Q-Logic: ACC142743. HCPCS: E1028
Multi-Axis JoystickMount
Retract4
6.1a. Fixed, In-line Joystick Bracket
Account Number: ___________ Date: ________________ Marked for: _____________________________________
6. JOYSTICK MOUNTING BRACKETSOptional. Select a mount to be used with a joystick selected in previous section.
Omit Joystick Mounting Bracket
Fixed, In-line, Bracket .............................................................................................................StandardQ-Logic Part: FRMASMB10617. VR2 Part: FRMASMB9532
Left Side MountPart: PTOINDV1225
Right Side MountPart: PTOINDV1226
Swing Away JoystickInline Mount (Right)
Swing Away JoystickOffset Mount (Right)
Q-Logic EX/NE Programmer ............................................ $545Part: ELEASMB6976
Q-Logic PC Programming Disk with Cable ........................... $750Part: ELEASMB5216
7. ELECTRONICS ACCESSORIESOptional.
8. TRU-BALANCE BARIATRIC POWER TILTREQUIRED.
8.1. Bariatric Tilt Seating
8.3. Seat Dimension - Width PackageREQUIRED.
8.2. Seat Dimension - WidthREQUIRED. Maximum seat width is 32". Part number is SETWDTH plus number following # below.
8.4. Seat Dimension - DepthREQUIRED. Maximum seat depth is 28". Part number is SETDPTH plus number following # below.
8.5. Seat Dimension - Depth PackageREQUIRED.
TRU-Balance bariatric power tilt section continued on following pages.
6.1c. Specialty Joystick MountsSelect a bracket and side to mount it.
Specialty Mount Side
Retract4 Mount ............................................$350Q-Logic Part: MEC138860. HCPCS: E1028Not available with VR2 joystick. Full 180° of movement that translates into multi-position use, straight, right off-set, left offset, or fold away. Joystick orientation varies as bracket is adjusted.
Multi-axis Mount ..........................................$100VR2 Part: ACC142531. HCPCS: E1028Q-Logic Part: ACC131216. HCPCS: E1028Allows height adjustment of joystick.
Stealth Swing-Away/Flip Down Bracket ..........$294.25Q-Logic Part: ST-TWBM480QL-Q. HCPCS: E1028SAJ Part: ST-TWBM480CJ-Q. HCPCS: E1028Not available with VR2 joystick. Allows the joystick to pivot to side of armrest, or flip-down if bracket is ad-justed.
Left Side MountPart: PTOINDV1225
Right Side MountPart: PTOINDV1226
TRU-Balance Bariatric Power Tilt ................................................................................................................................... $7,250Part: PTOINDV3263. HCPCS: E100240° center of gravity power tilt.
20”-24” Width PackagePart: MEC120322
24”-28” Width PackagePart: MEC120323
28”-32” Width PackagePart: MEC120325
20” D(#1010)
21” D(#1011)
22” D(#1012)
23” D(#1013)
24” D(#1014)
25” D(#1060)
26” D(#1061)
27” D(#1062)
28” D(#1063)
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)
20”-24” Depth PackagePart: FRMASMB10524
24”-28” Depth PackagePart: MEC147637
Page 4 of 11INFINFB3975/RevB/06MAY2019
Synergy Back ............................................................... $275Part: See XRefSelect a back cane type and height and back height.
Omit Back ............................................................ No ChargePart: PTOINDV1287Select a back cane type and height in following section.
Account Number: ___________ Date: ________________ Marked for: _____________________________________
2. Back Selection
TRU-Balance bariatric power tilt section continued on following page.
4. Back Cane Type SelectionSynergy Back Cane ................................................ No ChargePart: FRMASMB15844Select a back cane height.
2” Mesomorph (1” per side) Back Cane ...............................$195Part: FRMASMB12067Select a cane height.
4” Mesomorph (2” per side) Back Cane ...............................$195Part: FRMASMB12091Select a cane height.
2” Endomorph (1” per side) Back Cane ...............................$195Part: FRMASMB12115Select a cane height.
4” Endomorph (2” per side) Back Cane ...............................$195Part: FRMASMB12139Select a cane height.
3. Push HandlesPush Handles .......................................................... StandardPart: Configuration selection with back cane height
Omit Push Handles .........................................................$125Part: Configuration selection with back cane height
8.7. Seat to Floor HeightREQUIRED.
5. Overall Back HeightRefer to the TRU-Balance Bariatric Power Tilt back availability chart for stock order back size ranges. Parts: See XRef, configuration selection with back se-lection.
17” Overall High Back18” Overall High Back19” Overall High Back20” Overall High Back21” Overall High Back
22” Overall High Back23” Overall High Back24” Overall High Back25” Overall High Back
18.50" STFPart: PTOINDV3463
19.50" STFPart: PTOINDV3505
20.50" STFPart: PTOINDV3528
Full Length, Bariatric Armrests, 8"-12" H ................ No ChargeLeft part: FRMASMB6728. Right part: FRMASMB6729
Full Length, Bariatric Armrests, 10"-14"H ............... No ChargeLeft part: FRMASMB6730. Right part: FRMASMB6731.
8.8. Bariatric Tilt ArmrestsREQUIRED. Left (L) and right (R) boxes may be checked to configure different size arms within one section arm type.1a. Bariatric, Single Post, Heavy Duty, Height Adjustable, Removable ArmrestsMay interfere with swing-away laterals.
Full Length, Heavy Duty Armrests, 8"-12" H ............ No ChargeLeft part: FRMASMB9982. Right part: FRMASMB9983
Desk Length, Heavy Duty Armrests, 8"-12"H ............ No ChargeLeft part: FRMASMB9984. Right part: FRMASMB9985
Full Length, Heavy Duty Armrests, 10"-14" H ........... No ChargeLeft part: FRMASMB9986. Right part: FRMASMB9987
Desk Length, Heavy Duty Armrests, 10"-14"H .......... No ChargeLeft part: FRMASMB9988. Right part: FRMASMB9989
1b. Single-Post, Heavy Duty, 8"-12" Height Adjustable, Removable Armrests
1c. Single-Post, Heavy Duty, 10"-14" Height Adjustable, Removable Armrests
1d. Cantilever, Height Adjustable ArmrestsHeight adjustment from 11"-17" depends on cane height. Angle adjustable from -30° to +30°.
Full Length, Cantilever Armrests .......................... $97.50 ea.Left Part: FRMASMB16188. Right part: FRMASMB16189
Desk Length, Cantilever Armrests ......................... $97.50 ea.Left part: FRMASMB16190. Right part: FRMASMB16191
8.6. Bariatric Tilt Back OptionsREQUIRED. See the TRU-Balance Bariatric Power Tilt back availability chart for stock order back size ranges. Other size backs may be available with special order and extended lead time.1. Back Cane HeightParts: See XRef, configuration selection with push handles selection.
18” High Canes19” High Canes
20” High Canes21” High Canes
22” High Canes23” High Canes
24” High Canes25” High Canes
8. TRU-BALANCE BARIATRIC POWER TILT continued
Page 5 of 11INFINFB3975/RevB/06MAY2019
Account Number: ___________ Date: ________________ Marked for: _____________________________________
8. TRU-BALANCE BARIATRIC POWER TILT continued8.9. Armrest HeightREQUIRED. Set left and right armrest height. Note the available height range in the option description.
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
1. Left Armrest Height
2. Right Armrest Height
Bariatric Armpads ................................................. No ChargePart: UPSASMB1025Only available with bariatric armrests.
Straight Armpads ................................................... No ChargeDesk/Desk part: UPSASMB1022. Full/Full part: UPSASMB1021. Desk/Full part: UPSASMB1023Not available with bariatric armrests.
Waterfall Armpads ................................................. No ChargeDesk/Desk part: UPSASMB1025. Full/Full part: UPSASMB1024. Desk/Full part: UPSASMB1026May interfere with seat back. Not available with bariatric armrests.
Omit Armpads ...................................................... No ChargePart: PTOINDV1373
8.10. Bariatric Tilt ArmpadsREQUIRED with armrest selection above. Armpads are configured as pairs.
9. JOYSTICK BRACKET RECEIVERREQUIRED.
Standard Fixed Receiver ...........................StandardPart: ACC123525
Stealth Height Adjustable Receiver ................... $214Part: ST-ARM250C-Q. HCPCS: K0108
Height Adj. Receiver
Single Actuator Through Q-Logic 2 .................$1,895Controller and Interface (AM1)Part: ELEASMB7218. HCPCS: E2310
Single Actuator Through Q-Logic 2 ................ $2,895Controller and Interface (AAM)Part: ELEASMB7217. HCPCS: E2310
4 Way TogglePart: ELEASMB5925
4 Way Button TogglePart: ELEASMB5926
Quad Push ButtonPart: ELEASMB5924
10. TRU-BALANCE 3 POWER POSITIONING ELECTRONICSREQUIRED.
10.1c. Q-Logic 2 Controls through Joystick
Single Actuator Control, Power Tilt Through Toggle ........................................................................................................No ChargePart: ELEASMB6395Select a side to mount toggle.
Left Side Toggle Right Side TogglePart: ELEASMB5156 Part: ELEASMB5157
10.1a. Tilt Only through Toggle
Q-Logic 2 Optional Switch ControlNot available with AM1 electronics. Switch will be mounted to same side of joystick.
10.1b. VR2 through JoystickSingle Actuator Control Through VR2 Joystick ................................................................................................................... $1,895Part: ELE132816. HCPCS: E2310
Switch Controls
4 Way Toggle
4 Way ButtonToggle
Quad PushButton
Seat Mounted, LED, Full Light Package ...............................................................................................................................$995Part: ELE131477
Accessory Bar ...............................................................................................................................................................$10016"W-20"W part: MEC143975. 20"-24" part: MEC146018. 24"-28" part: MEC146050. 28"-32" part: MEC146051.
11. FULL LIGHT PACKAGEOptional. Requires Q-Logic 2 Joystick for Full Light Package.
12. ACCESSORY BAROptional.
Page 6 of 11INFINFB3975/RevB/06MAY2019
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Legrests section continued on following page.
Headrests
14.1. Headrest Pads
14.2. Headrest Brackets
14. HEADRESTSOptional. Select a headrest pad and bracket.
Stealth’s Worlds Best Removable ..................$220.50Headrest Bracket (TWB485-1) (C)Part: FRMASMB15999. HCPCS: E1028
Stealth Multi-Axis Removable Headrest..........$160.50Bracket (HMO475P) (D)Part: HDWASMB1084. HCPCS: E1028
Stealth 8” Comfort Plus (CP450) ................... $151.94Part: POS148484. HCPCS: E0955
Stealth 10” Comfort Plus (CP250)(A) ............. $151.94Part: SETHEAD1057. HCPCS: E0955
Stealth 14” Comfort Plus (CP150) ................. $151.94Part: INDPART2327. HCPCS: E0955
Pediatric Comfort Plus (6”Wx4.5”H) ............. $151.94(CPN350)Part: SETHEAD1069. HCPCS: E0955
Stealth Small Contoured (9.75”Wx3”H) .............$64.20(STL-OTSM250)Part: SETHEAD1052. HCPCS: E0955
Stealth Large Contoured (11”Wx6”H) (B) ........... $80.25(STL-OTLG150)Part: SETHEAD1053. HCPCS: E0955
38” Lap BeltPart: ACCBELT1006
50” Lap BeltPart: ACCBELT1000
60” Lap BeltPart: ACCBELT1002
70” Lap BeltPart: ACCBELT1003
80” Lap BeltPart: ACCBELT1004
90” Lap BeltPart: ACCBELT1001
i-Fit 60” Single Pull, Push Button, Medium ...........................$86(7.5”) Padded, 1.5” Belt (IFPB5213)Part: ST-IFPB5213-Q
i-Fit 60” Single Pull, Push Button, Large ..............................$86Padded (9.5”), 2” Belt (IFPB5314)Part: ST-IFPB5314-Q
i-Fit 60” Single Pull, Push Button, Extra Large ......................$86Padded (11.5”), 2” Belt (IFPB5315)Part: ST-IFPB5315-Q
13.1a. Standard Lap Belts
13.1b. Optional Lap Belts
13. LAP BELTSREQUIRED. Select a lap belt below.
Center Mount Foot Platform ............................................................................................................................................ $25020"-24"W part: RIG155637. 24"-28"W part: RIG155527. 28"-23"W part: RIG155528
15.1. Manually Adjustable Center Mount Foot Platform
17"Wx13"D One Piece Foot PlatformPart: RIG123289
17"Wx16"D One Piece Foot PlatformPart: RIGASMB7120011
2. Footplates
1. Foot Platform Assembly
Reversed Dartex Calf Pad Cover (pair) ............................... $150Part: RIG133719
Reversed Dartex Panel Cover (pair) .................................. $150Part: RIG134744
Wheel Bumpers (pair) ............................................. $12.50 ea.Part: WHLASMB1578 x2
Footplate Connector ....................................................... $15Part: RIGASMB7120023
4. Additional Accessories
3. Center Mount Calf SupportCalf pad and panel covers include 1/2” of soft visco foam.
Large Calf Pads (pair) 8” taper to 6”Wx8”H ........................ $150Part: RIGASMB7120019
Large Calf Panel 24”Wx8”H ............................................ $200Part: RIG123824
15.2. Heavy Duty, Drop-In, Swing-Away LegrestsSelect a configuration, a legrest with extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.1. Drop-In Legrest Selection
2. Angle Adjustable Footplate(s) with Heel Loops
3. Accessories
70° HD Drop-in with 12"-14.5" Length ............... No ChargeLower ExtensionPair part: FRMASMB4762. Left: RIG137706. Right: RIG137707
70° HD Drop-in with 14.5-18" Length ............... No ChargeLower ExtensionPair 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+E0951
8”Wx11”D2 .....................................................$85 ea.Pair part: FRMASMB4744. Left: RIG137708. Right: RIG137709.HCPCS: K0040+E0951
Wheel Bumper(s) ..........................................................................................................................................$12.50 ea.Pair part: WHLASMB1578. Left part: WHL169510. Right part: WHL169511
15. 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.
Page 7 of 11INFINFB3975/RevB/06MAY2019
Account Number: ___________ Date: ________________ Marked for: _____________________________________
15. LEGRESTS continued
1. Heavy Duty, Elevating Legrest Selection
2. Lower Extension
3. Reinforced Footplates(s)
4. Angle Adjustable Footplates(s) with Heel Loops
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+E0953
6”Wx11”D ......................................................$85 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797.HCPCS: K0040+E0953
8”Wx11”D ......................................................$85 ea.Pair part: FRMASMB4744. Left: RIG137798. Right: RIG137799.HCPCS: K0040+E0953May cause interference with seat widths less than 20"
11”-14” LengthPart: FRMASMB4755. Left: RIG138026. Right: RIG138030For reinforced footplates only.
12”-14.5” LengthPart: FRMASMB4752. Left: FRMASMB5391. Right: FRMASMB4723For angle adjustable footplates only.
14”-17” LengthPart: FRMASMB4756. Left: RIG138033. Right: RIG138035For reinforced footplates only.
14.5”-18” LengthPart: FRMASMB4753. Left: FRMASMB4724. Right: FRMASMB5392For angle adjustable footplates only.
15.3. Heavy Duty, Elevating LegrestsSelect a configuration, a legrest with extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.
7” L(#3470)
7.5” L(#3471)
8” L(#3472)
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)
18.5” L(#3493)
19” L(#3494)
19.5” L(#3495)
20” L(#3496)
20.5” L(#3497)
21” L(#3498)
21.5” L(#3600)
22” L(#3669)
22.5” L(#3670)
16. SET LEGREST LENGTHREQUIRED with matching left and right legrest configuration. 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. Non-matching or individual legrest configurations lengths are not set by the manufacturer.
17.1. Seat Cushion Model Selection
17. SEAT CUSHIONOptional. Specific cushion/component sizes available, part numbers, and special order cushions can be found on the respective complete Stealth Cushion Order Forms. This section allows a quick selection of a single cushion. The XXYY portion of the part number directly relates to the dimensions of the cushion, where XX represents the width and YY represents the depth.
TRU-Comfort 2 SPP, E2607, 20"W .....................$400TRU-Comfort 2 SPP, E2608, 22"W .....................$500
Simplicity G, E2601, 20"W .............................. $110Simplicity G, E2602, 22"W to 24"W ................... $165
Spectrum Gel SPP, E2607, 20"W .......................$460Spectrum Gel SPP, E2608, 22"W to 24"W ...........$530
Spectrum Foam SPP, E2607, 20"W ....................$460Spectrum Foam SPP, E2608, 22"W to 32"W .........$530
Stealth Simplicity G CushionGeneral use cushion with Stealth Tek 2, 2-way stretch, breathable cover. Weight capacity for 16" to 20" W is 350 lbs, over 20"W is 400 lbs.Part series: ST-SIMGXXYY
Stealth Spectrum Gel SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner. Weight capacity for 20" W is 350 lbs, over 20"W is 550 lbs.Part series: ST-SPCGSPPXXYY
Stealth TRU-Comfort 2 SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Weight capacity for 16" to 20" W is 350 lbs, over 20"W is 450 lbs.Part series: ST-TC2SPPXXYY
Stealth Spectrum Foam SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner. Weight capacity for 20" W is 350 lbs, over 20"W is 650 lbs.Part series: ST-SPCFSPPXXYY
Solution SPP, E2607, 20"W ..............................$375Solution SPP, E2608, 22"W to 24"W ..................$430
Stealth Solution SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner. Weight capacity for 20" W is 350 lbs, over 20"W is 550 lbs.Part series: ST-SOLSPPXXYY
Glacial SP, E2603, 20"W .................................$330Glacial SP, E2604, 22"W to 24"W ......................$440
Stealth Glacial SP CushionSkin protection with Coolcore, 4-way stretch, breathable cover. Weight capacity is for 20"W is 350 lbs, over 20"W is 450 lbs.Part series: ST-GLSPXXYY
Premiere P, E2605, 20"W ...............................$325
Stealth Premiere P CushionPositioning with Coolcore, 4-way stretch, breathable cover. Weight capacity for 20"W is 350 lbs.Part series: ST-PREMPXXYY
Seat cushion section continued on following page.
Page 8 of 11INFINFB3975/RevB/06MAY2019
17.3. Seat Cushion Substitute/Add Fluid Proof Liners
17.4. Seat Cushion Substitute CoverAn additional cover may be ordered or the standard cover may be substituted with a cover by checking the option in subsection 2. The "*prefix" of the part number will be the part prefix of the cushion model selected above. For example, SPCGSPP-NBLK1816 will be an additional coolcore cover for a Spectrum Gel cushion.
17.2. Seat Cushion DimensionsREQUIRED with cushion model selection. Select to match or pick non-matching dimensions. See respective cushion order form for available sizes.
Fluid Proof Urethane Liner ......................................... $50-$70Part: URL1709070-XXYYNot available with Simplicity, or TRU-Comfort 2.
Fluid Proof Polyurethane Liner .................................... $55-$75Part: PUL1709030-XXYYNot available with Simplicity.
Match Seat Width and Depth
Stealth Tek 2 Cover ................................................ No ChargePart: *prefix-TBLKXXYYNot available with Simplicity, TRU-Comfort 2, and Premiere.
Mesh Cover .......................................................... No ChargePart: *prefix-MBLKXXYYNot available with Simplicity or TRU-Comfort 2.
Cushion Width Cushion Depth
20" W 22" W 24" W 26" W 28" W 30" W 32" W 20" D 21" D 22" D 23" D 24" D 26" D 28" D
17. SEAT CUSHION continued
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Group 24, Gel Cell, Interceptor Battery ........................ $365 ea.Part: BAT1704614. HCPCS: E2363
No batteries. Provider will assume responsibility of batteries.Part: Configuration selection
Group 24, Gel Cell, MK Battery ................................... $495 ea.Part: BATGEL1009. HCPCS: E2363
19. BATTERIESREQUIRED. The powerchair requires 2 batteries and will be installed if ordered.
Oxygen Holder ............................................................. $200Part: ACC125006 HCPCS: E2208
Stealth Large Tablet Holder ............................................ $375Not available with desk length armrests.Part: ACC7120005
Stealth Deluxe Cell Phone/Media Holder .............................$195Not available with desk length armrests. Part: ACC7120006
Cup Holder .......................................................... No ChargePart: ACCASMB2634
20. 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
Military Patches
1. Bracket
2. Pads
3. Installation
Swing-away, Rail Mounts, pair (TWBTLTC) ......................$472.50Part: INDPART2896. HCPCS: E1028
Curved Pads, 3”x5”, pair (TWBL-3X5) ................................ $210Part: INDPART2663. HCPCS: E0956
Curved Pads, 4”x6”, pair (TWBL-4X6) ................................ $210Part: INDPART2664. HCPCS: E0956
Install LateralsPart: PTOINDV3499
Do Not InstallPart: PTOINDV3500
21.1. Stealth Thoracic LateralsLaterals are not available with the omit back option.
21. MANUFACTURER INSTALLED POSITIONING COMPONENTSOptional. More options are available on the Positioning Components Order Form.
18. PROVIDER INSTALLED ACCESSORIESOptional.
Manufacturer installed positioning components section continued on following page.
Page 9 of 11INFINFB3975/RevB/06MAY2019
Account Number: ___________ Date: ________________ Marked for: _____________________________________
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
1. Pelvic/Thigh Guide Bracket
2. Pelvic/Thigh Guide Adapter
21.3. Stealth Pelvic/Thigh GuidesPelvic/thigh guides may interfere with the joystick receiver block and down posts. Please provide quantity next to check box.
2” 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.
3. Pelvic/Thigh Guide Pad^Please verify the appropriate billing code to be used for this item with all third-party payors.
4. Pelvic/Thigh Guide Installation
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
Install on LeftPart: PTOINDV3585
Install on RightPart: PTOINDV3586
Do Not InstallPart: PTOINDV3719
4. UniLink Pelvic/Thigh Guide InstallationInstall on LeftPart: PTOINDV3585
Install on RightPart: PTOINDV3586
Do Not InstallPart: PTOINDV3719
1. UniLink Pelvic/Thigh Hardware
2. UniLink Pelvic/Thigh Pads^Please verify the appropriate billing code to be used for this item with all third-party payors.
3. UniLink Pelvic/Thigh Additional Links
21.2. Stealth UniLink Pelvic/Thigh Guide
UniLink, 5" Height Adjustable & Removable Hardware ... $245 ea.Part: ST-UTTP5-Q
UniLink, 7" Height Adjustable & Removable Hardware... $255 ea.Part: ST-UTTP7-Q
UniLink, 4" x 4" Pad ..............................$95 ea.Part: ST-UTP544056100-Q
UniLink, 4" x 8" Pad ............................. $105 ea.Part: ST-UTP548056100-Q
UniLink, 4" x 12" Pad ........................... $125 ea.Part: ST-UTP548056100-Q
UniLink, 1.5" Link ............................... $75 ea.Part: ST-UIL00I150A000-Q
UniLink, 2" Link ................................... $75 ea.Part: ST-UIL00I200A00-Q
UniLink Pad & Hardware
21. MANUFACTURER INSTALLED POSITIONING COMPONENTS continued
22.1. Stealth Foot Boxes^Please verify the appropriate billing code to be used for this item with all third-party payors.
Stealth 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^
22.2. 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
22. PROVIDER INSTALLED POSITIONING COMPONENTSOptional. More options are available on the Positioning Components Order Form.
Provider installed positioning components section continued on following page.
Page 10 of 11INFINFB3975/RevB/06MAY2019
1" Ball Kit for Facial Laterals (TWB-1BK) (D) ..... $80.25Part: POS150532Required with facial laterals to mount to comfort head-rest brackets.
Egg 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, ..................$250 ea. 18" Rod (C)
Part: ST-SUS18-Q Allows mounting of facial pads and attaches to the headrest
22.4. Stealth i-Fit Chest Harness
22.5. Stealth i-Fit Chest Straps
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 ............. $90 ea.(IFCS4113)Part: ST-IFCS4113-Q. HCPCS: E0960
Chest Strap, Large w/ Belt Anchor ................ $90 ea.(IFCS4114)Part: ST-IFCS4114-Q. HCPCS: E0960
Contoured and ClassicChest Harness
Chest Strap22.6. Stealth Swing-Away Headrest MountsThese swing-away headrest mounts are only available with the Stealth Comfort Series headrests. The 1" ball kit must be selected to mount the facial lateral to the headrest bracket. Also select a facial pad(s) with the facial lateral(s).
Facial 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
Left and Right FacialLateral with Pads
Headrest Accessories
2. Elbow Support Pad
1. Elbow Support Bracket22.3. Stealth Elbow Support
Left,Swing-Away, Elbow Support Bracket ..............$183.75 ea. 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 Bracket ............$183.75 ea. 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
Facial Lateral Pads and Accessories
Account Number: ___________ Date: ________________ Marked for: _____________________________________
Specialty controls section continued on following page.
23.1. SCIM ModuleOptional.
SCIM Module Kit for Q-Logic 2......................................................................................................... $525Part: CTL168055Available with Q-Logic 2 EX Joystick selection above. Allows use of joystick display for specialty devices and offers 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
23. SPECIALTY CONTROLSOptional. Select a type of specialty controls below or to refer to the specialty controls order form.
22. PROVIDER INSTALLED POSITIONING COMPONENTS continued
23.2. Q-Logic 2 Stand Alone JoystickQ-Logic 2 EX Stand Alone Joystick ...................................................................................................$700Part: ELEASMB5205Up to 3 drive profiles and 1 seating profile when used alone. Use in conjunction with Enhanced Display for up to 5 pro-files and auxiliary functions such as Bluetooth Mouse and IR. Includes charger port mounting bracket and multiplier box harness. EX Stand Alone Joystick
Page 11 of 11INFINFB3975/RevB/06MAY2019
Account Number: ___________ Date: ________________ Marked for: _____________________________________
23. SPECIALTY CONTROLS continued
Enhanced Display
23.3. Enhanced Display
Q-Logic 2 Enhanced Display ShroudRequired with Q-Logic 2 Enhanced Display selection above. Reference colors shown on page 2.
Red CorvettePart: DGN137729-PRD1
Electric BluePart: DGN137729-PBU9
Back in BlackPart: DGN137729-PBK1
White SatinPart: DGN137729-PWH2
Pretty in PinkPart: DGN137729-PPK3
Deep PurplePart: DGN137729-PPR5
Lime LightPart: DGN137729-PGN7
Grey StreetPart: DGN137729-PSL3
Silver BulletPart: DGN137729-PSL7
Midnight BluePart: DGN137729-PBU10
Orange CrushPart: DGN137729-POR6
Yellow BlazePart: DGN137729-PYL3
Black, Soft Touch ....................................StandardPart: DGN137728
Non-matching Joystick Shroud.......................... $50Select color below
Match Joystick Shroud to Base Color .................. $50Part: See color below
Q-Logic 2 Enhanced Display Kit .....................................................................................................$1,720Part: KIT140039Select 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.
23.4. 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
23.5. Sip and Puff DriveSip and Puff Module for Q-Logic 2 ..................................................................................................$1,895Part: KITASMB1697. HCPCS: E2325 Includes module and bus cable.
Sip & Puff Module
23.6. Egg Switches
23.7. Switch Adapter
Egg Switch
Red Egg Switch (ESRED) ..................... $80.85 ea. Part: SWTMCRO1077
Blue Egg Switch (ESBLU) .................... $80.85 ea.Part: SWTMCRO1079
Black Egg Switch (ESBLK) ................... $80.85 ea.Part: SWTMCRO1081
Green Egg Switch (ESGRN) ................. $80.85 ea.Part: SWTMCRO1078
Yellow Egg Switch (ESYEL) ................. $80.85 ea.Part: SWTMCRO1080
2 to 1 Switch Adapter .................................................................................................................................................. $13.39Part: DWR1361H037 Connects 2 single switches to a stereo jack to act as a dual switch.
Alternative Controls & Electronics Order Form Positioning Components Order Form
24. REFERENCE ORDER FORMSOptional. Select below to note that additional order forms will accompany this order form. This will also be a link in interactive forms.
©2019 Quantum Rehab - A Pride Mobility Products Corporation company. All rights reserved.
Quantum® Rehab401 York Ave., Duryea, PA 18642Phone: 866-800-2002 | Fax: 866-707-3422 | Email: [email protected]
facebook.com/QuantumRehab
youtube.com/QuantumRehab
instagram.com/quantum_rehab
twitter.com/quantumrehab
Option Name MSRP Part Number Manufacturer Extended Description
Synergy Back $275 SETASMB6463 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,17"H,W/CUSHION,(16"W X 14"H BACK)
SETASMB6639 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,18"H,W/CUSHION,(16"W X 14"H BACK)
SETASMB6474 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,19"H,W/CUSHION,(16"W X 16"H BACK)
SETASMB6650 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,20"H,W/CUSHION,(16"W X 16"H BACK)
SETASMB6493 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,21"H,W/CUSHION,(16"W X 18"H BACK)
SETASMB6669 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,22"H,W/CUSHION,(16"W X 18"H BACK)
SETASMB6512 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,23"H,W/CUSHION,(16"W X 20"H BACK)
SETASMB6688 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,24"H,W/CUSHION,(16"W X 20"H BACK)
SETASMB6531 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,25"H,W/CUSHION,(16"W X 22"H BACK)
SETASMB6464 SEAT BACK,ASSY,SYNERGY STANDARD BACK,17"W,17"H,W/CUSHION,(17"W X 14"H BACK)
SETASMB6640 SEAT BACK,ASSY,SYNERGY STANDARD BACK,17"W,18''D,W/CUSHION,(17"W X 14"H BACK)
SETASMB6494 SEAT BACK,ASSY,SYNERGY STANDARD BACK,17"W,21"H,W/CUSHION,(17"W X 18"H BACK)
SETASMB6670 SEAT BACK,ASSY,SYNERGY STANDARD BACK,17"W,22"H,W/CUSHION,(17"W X 18"H BACK)
SETASMB6513 SEAT BACK,ASSY,SYNERGY STANDARD BACK,17"W,23"H,W/CUSHION,(17"W X 20"H BACK)
SETASMB6689 SEAT BACK,ASSY,SYNERGY STANDARD BACK,17"W,24"H,W/CUSHION,(17"W X 20"H BACK)
SETASMB6532 SEAT BACK,ASSY,SYNERGY STANDARD BACK,17"W,25"H,W/CUSHION,(17"W X 22"H BACK)
SETASMB6465 SEAT BACK,ASSY,SYNERGY STANDARD BACK,18"W,17"H,W/CUSHION,(18"W X 14"H BACK)
SETASMB6641 SEAT BACK,ASSY,SYNERGY STANDARD BACK,18"W,18"H,W/CUSHION,(18"W X 14"H BACK)
SETASMB6476 SEAT BACK,ASSY,SYNERGY STANDARD BACK,18"W,19"H,W/CUSHION,(18"W X 16"H BACK)
SETASMB6652 SEAT BACK,ASSY,SYNERGY STANDARD BACK,18"W,20"H,W/CUSHION,(18"W X 16"H BACK)
SETASMB6495 SEAT BACK,ASSY,SYNERGY STANDARD BACK,18"W,21"H,W/CUSHION,(18"W X 18"H BACK)
SETASMB6671 SEAT BACK,ASSY,SYNERGY STANDARD BACK,18"W,22"H,W/CUSHION,(18"W X 18"H BACK)
SETASMB6514 SEAT BACK,ASSY,SYNERGY STANDARD BACK,18"W,23"H,W/CUSHION,(18"W X 20"H BACK)
SETASMB6690 SEAT BACK,ASSY,SYNERGY STANDARD BACK,18"W,24"H,W/CUSHION,(18"W X 20"H BACK)
SETASMB6533 SEAT BACK,ASSY,SYNERGY STANDARD BACK,18"W,25"H,W/CUSHION,(18"W X 22"H BACK)
SETASMB6466 SEAT BACK,ASSY,SYNERGY STANDARD BACK,19"W,17"H,W/CUSHION,(19"W X 14"H BACK)
SETASMB6642 SEAT BACK,ASSY,SYNERGY STANDARD BACK,19"W,18"H,W/CUSHION,(19"W X 14"H BACK)
SETASMB6477 SEAT BACK,ASSY,SYNERGY STANDARD BACK,19"W,19"H,W/CUSHION,(19"W X 16"H BACK)
Section NameQuantum 1450 Cross Reference Spreadsheet - TRU-Balance Bariatric Power Tilt
TRU-BALANCE BARIATRIC POWER TILT: Back Cushion Configuration
Page 1 of 5
Option Name MSRP Part Number Manufacturer Extended DescriptionSection Name
Quantum 1450 Cross Reference Spreadsheet - TRU-Balance Bariatric Power Tilt
SETASMB6653 SEAT BACK,ASSY,SYNERGY STANDARD BACK,19"W,20"H,W/CUSHION,(19"W X 16"H BACK)
SETASMB6496 SEAT BACK,ASSY,SYNERGY STANDARD BACK,19"W,21"H,W/CUSHION,(19"W X 18"H BACK)
SETASMB6672 SEAT BACK,ASSY,SYNERGY STANDARD BACK,19"W,22"H,W/CUSHION,(19"W X 18"H BACK)
SETASMB6515 SEAT BACK,ASSY,SYNERGY STANDARD BACK,19"W,23"H,W/CUSHION,(19"W X 20"H BACK)
SETASMB6691 SEAT BACK,ASSY,SYNERGY STANDARD BACK,19"W,24"H,W/CUSHION,(19"W X 20"H BACK)
SETASMB6534 SEAT BACK,ASSY,SYNERGY STANDARD BACK,19"W,25"H,W/CUSHION,(19"W X 22"H BACK)
SETASMB6467 SEAT BACK,ASSY,SYNERGY STANDARD BACK,20"W,17"H,W/CUSHION,(20"W X 14"H BACK)
SETASMB6643 SEAT BACK,ASSY,SYNERGY STANDARD BACK,20"W,18"H,W/CUSHION,(20"W X 14"H BACK)
SETASMB6478 SEAT BACK,ASSY,SYNERGY STANDARD BACK,20"W,19"H,W/CUSHION,(20"W X 16"H BACK)
SETASMB6654 SEAT BACK,ASSY,SYNERGY STANDARD BACK,20"W,20"H,W/CUSHION,(20"W X 16"H BACK)
SETASMB6497 SEAT BACK,ASSY,SYNERGY STANDARD BACK,20"W,21"H,W/CUSHION,(20"W X 18"H BACK)
SETASMB6673 SEAT BACK,ASSY,SYNERGY STANDARD BACK,20"W,22"H,W/CUSHION,(20"W X 18"H BACK)
SETASMB6516 SEAT BACK,ASSY,SYNERGY STANDARD BACK,20"W,23"H,W/CUSHION,(20"W X 20"H BACK)
SETASMB6692 SEAT BACK,ASSY,SYNERGY STANDARD BACK,20"W,24"H,W/CUSHION,(20"W X 20"H BACK)
SETASMB6535 SEAT BACK,ASSY,SYNERGY STANDARD BACK,20"W,25"H,W/CUSHION,(20"W X 22"H BACK)
SETASMB6468 SEAT BACK,ASSY,SYNERGY STANDARD BACK,21"W,17"H,W/CUSHION,(21"W X 14"H BACK)
SETASMB6644 SEAT BACK,ASSY,SYNERGY STANDARD BACK,21"W,18"H,W/CUSHION,(21"W X 14"H BACK)
SETASMB6479 SEAT BACK,ASSY,SYNERGY STANDARD BACK,21"W,19"H,W/CUSHION,(21"W X 16"H BACK)
SETASMB6655 SEAT BACK,ASSY,SYNERGY STANDARD BACK,21"W,20"H,W/CUSHION,(21"W X 16"H BACK)
SETASMB6498 SEAT BACK,ASSY,SYNERGY STANDARD BACK,21"W,21"H,W/CUSHION,(21"W X 18"H BACK)
SETASMB6674 SEAT BACK,ASSY,SYNERGY STANDARD BACK,21"W,22"H,W/CUSHION,(21"W X 18"H BACK)
SETASMB6517 SEAT BACK,ASSY,SYNERGY STANDARD BACK,21"W,23"H,W/CUSHION,(21"W X 20"H BACK)
SETASMB6693 SEAT BACK,ASSY,SYNERGY STANDARD BACK,21"W,24"H,W/CUSHION,(21"W X 20"H BACK)
SETASMB6536 SEAT BACK,ASSY,SYNERGY STANDARD BACK,21"W,25"H,W/CUSHION,(21"W X 22"H BACK)
SETASMB6469 SEAT BACK,ASSY,SYNERGY STANDARD BACK,22"W,17"H,W/CUSHION,(22"W X 14"H BACK)
SETASMB6645 SEAT BACK,ASSY,SYNERGY STANDARD BACK,22"W,18"H,W/CUSHION,(22"W X 14"H BACK)
SETASMB6480 SEAT BACK,ASSY,SYNERGY STANDARD BACK,22"W,19"H,W/CUSHION,(22"W X 16"H BACK)
SETASMB6656 SEAT BACK,ASSY,SYNERGY STANDARD BACK,22"W,20"H,W/CUSHION,(22"W X 16"H BACK)
Page 2 of 5
Option Name MSRP Part Number Manufacturer Extended DescriptionSection Name
Quantum 1450 Cross Reference Spreadsheet - TRU-Balance Bariatric Power Tilt
SETASMB6499 SEAT BACK,ASSY,SYNERGY STANDARD BACK,22"W,21"H,W/CUSHION,(22"W X 18"H BACK)
SETASMB6675 SEAT BACK,ASSY,SYNERGY STANDARD BACK,22"W,22"H,W/CUSHION,(22"W X 18"H BACK)
SETASMB6518 SEAT BACK,ASSY,SYNERGY STANDARD BACK,22"W,23"H,W/CUSHION,(22"W X 20"H BACK)
SETASMB6694 SEAT BACK,ASSY,SYNERGY STANDARD BACK,22"W,24"H,W/CUSHION,(22"W X 20"H BACK)
SETASMB6537 SEAT BACK,ASSY,SYNERGY STANDARD BACK,22"W,25"H,W/CUSHION,(22"W X 22"H BACK)
SETASMB6470 SEAT BACK,ASSY,SYNERGY STANDARD BACK,23"W,17"H,W/CUSHION,(23"W X 14"H BACK)
SETASMB6646 SEAT BACK,ASSY,SYNERGY STANDARD BACK,23"W,18"H,W/CUSHION,(23"W X 14"H BACK)
SETASMB6481 SEAT BACK,ASSY,SYNERGY STANDARD BACK,23"W,19"H,W/CUSHION,(23"W X 16"H BACK)
SETASMB6657 SEAT BACK,ASSY,SYNERGY STANDARD BACK,23"W,20"H,W/CUSHION,(23"W X 16"H BACK)
SETASMB6500 SEAT BACK,ASSY,SYNERGY STANDARD BACK,23"W,21"H,W/CUSHION,(23"W X 18"H BACK)
SETASMB6676 SEAT BACK,ASSY,SYNERGY STANDARD BACK,23"W,22"H,W/CUSHION,(23"W X 18"H BACK)
SETASMB6519 SEAT BACK,ASSY,SYNERGY STANDARD BACK,23"W,23"H,W/CUSHION,(23"W X 20"H BACK)
SETASMB6695 SEAT BACK,ASSY,SYNERGY STANDARD BACK,23"W,24"H,W/CUSHION,(23"W X 20"H BACK)
SETASMB6538 SEAT BACK,ASSY,SYNERGY STANDARD BACK,23"W,25"H,W/CUSHION,(23"W X 22"H BACK)
SETASMB6471 SEAT BACK,ASSY,SYNERGY STANDARD BACK,24"W,17"H,W/CUSHION,(24"W X 14"H BACK)
SETASMB6647 SEAT BACK,ASSY,SYNERGY STANDARD BACK,24"W,18"H,W/CUSHION,(24"W X 14"H BACK)
SETASMB6482 SEAT BACK,ASSY,SYNERGY STANDARD BACK,24"W,19"H,W/CUSHION,(24"W X 16"H BACK)
SETASMB6658 SEAT BACK,ASSY,SYNERGY STANDARD BACK,24"W,20"H,W/CUSHION,(24"W X 16"H BACK)
SETASMB6501 SEAT BACK,ASSY,SYNERGY STANDARD BACK,24"W,21"H,W/CUSHION,(24"W X 18"H BACK)
SETASMB6677 SEAT BACK,ASSY,SYNERGY STANDARD BACK,24"W,22"H,W/CUSHION,(24"W X 18"H BACK)
SETASMB6520 SEAT BACK,ASSY,SYNERGY STANDARD BACK,24"W,23"H,W/CUSHION,(24"W X 20"H BACK)
SETASMB6696 SEAT BACK,ASSY,SYNERGY STANDARD BACK,24"W,24"H,W/CUSHION,(24"W X 20"H BACK)
SETASMB6539 SEAT BACK,ASSY,SYNERGY STANDARD BACK,24"W,25"H,W/CUSHION,(24"W X 22"H BACK)
SETASMB6483 SEAT BACK,ASSY,SYNERGY STANDARD BACK,25"W,19"H,W/CUSHION,(25"W X 16"H BACK)
SETASMB6659 SEAT BACK,ASSY,SYNERGY STANDARD BACK,25"W,20"H,W/CUSHION,(25"W X 16"H BACK)
SETASMB6502 SEAT BACK,ASSY,SYNERGY STANDARD BACK,25"W,21"H,W/CUSHION,(25"W X 18"H BACK)
SETASMB6678 SEAT BACK,ASSY,SYNERGY STANDARD BACK,25"W,22"H,W/CUSHION,(25"W X 18"H BACK)
SETASMB6521 SEAT BACK,ASSY,SYNERGY STANDARD BACK,25"W,23"H,W/CUSHION,(25"W X 20"H BACK)
Page 3 of 5
Option Name MSRP Part Number Manufacturer Extended DescriptionSection Name
Quantum 1450 Cross Reference Spreadsheet - TRU-Balance Bariatric Power Tilt
SETASMB6697 SEAT BACK,ASSY,SYNERGY STANDARD BACK,25"W,24"H,W/CUSHION,(25"W X 20"H BACK)
SETASMB6540 SEAT BACK,ASSY,SYNERGY STANDARD BACK,25"W,25"H,W/CUSHION,(25"W X 22"H BACK)
SETASMB6484 SEAT BACK,ASSY,SYNERGY STANDARD BACK,26"W,19"H,W/CUSHION,(26"W X 16"H BACK)
SETASMB6660 SEAT BACK,ASSY,SYNERGY STANDARD BACK,26"W,20"H,W/CUSHION,(26"W X 16"H BACK)
SETASMB6503 SEAT BACK,ASSY,SYNERGY STANDARD BACK,26"W,21"H,W/CUSHION,(26"W X 18"H BACK)
SETASMB6679 SEAT BACK,ASSY,SYNERGY STANDARD BACK,26"W,22"H,W/CUSHION,(26"W X 18"H BACK)
SETASMB6522 SEAT BACK,ASSY,SYNERGY STANDARD BACK,26"W,23"H,W/CUSHION,(26"W X 20"H BACK)
SETASMB6698 SEAT BACK,ASSY,SYNERGY STANDARD BACK,26"W,24"H,W/CUSHION,(26"W X 20"H BACK)
SETASMB6541 SEAT BACK,ASSY,SYNERGY STANDARD BACK,26"W,25"H,W/CUSHION,(26"W X 22"H BACK)
SETASMB6485 SEAT BACK,ASSY,SYNERGY STANDARD BACK,27"W,19"H,W/CUSHION,(27"W X 16"H BACK)
SETASMB6661 SEAT BACK,ASSY,SYNERGY STANDARD BACK,27"W,20"H,W/CUSHION,(27"W X 16"H BACK)
SETASMB6504 SEAT BACK,ASSY,SYNERGY STANDARD BACK,27"W,21"H,W/CUSHION,(27"W X 18"H BACK)
SETASMB6680 SEAT BACK,ASSY,SYNERGY STANDARD BACK,27"W,22"H,W/CUSHION,(27"W X 18"H BACK)
SETASMB6523 SEAT BACK,ASSY,SYNERGY STANDARD BACK,27"W,23"H,W/CUSHION,(27"W X 20"H BACK)
SETASMB6699 SEAT BACK,ASSY,SYNERGY STANDARD BACK,27"W,24"H,W/CUSHION,(27"W X 20"H BACK)
SETASMB6542 SEAT BACK,ASSY,SYNERGY STANDARD BACK,27"W,25"H,W/CUSHION,(27"W X 22"H BACK)
SETASMB6486 SEAT BACK,ASSY,SYNERGY STANDARD BACK,28"W,19"H,W/CUSHION,(28"W X 16"H BACK)
SETASMB6662 SEAT BACK,ASSY,SYNERGY STANDARD BACK,28"W,20"H,W/CUSHION,(28"W X 16"H BACK)
SETASMB6505 SEAT BACK,ASSY,SYNERGY STANDARD BACK,28"W,21"H,W/CUSHION,(28"W X 18"H BACK)
SETASMB6681 SEAT BACK,ASSY,SYNERGY STANDARD BACK,28"W,22"H,W/CUSHION,(28"W X 18"H BACK)
SETASMB6524 SEAT BACK,ASSY,SYNERGY STANDARD BACK,28"W,23"H,W/CUSHION,(28"W X 20"H BACK)
SETASMB6700 SEAT BACK,ASSY,SYNERGY STANDARD BACK,28"W,24"H,W/CUSHION,(28"W X 20"H BACK)
SETASMB6543 SEAT BACK,ASSY,SYNERGY STANDARD BACK,28"W,25"H,W/CUSHION,(28"W X 22"H BACK)
SETASMB6487 SEAT BACK,ASSY,SYNERGY STANDARD BACK,29''W,19"H,W/CUSHION,(29"W X 16"H BACK)
SETASMB6663 SEAT BACK,ASSY,SYNERGY STANDARD BACK,29''W,20"H,W/CUSHION,(29"W X 16"H BACK)
SETASMB6506 SEAT BACK,ASSY,SYNERGY STANDARD BACK,29''W,21"H,W/CUSHION,(29"W X 18"H BACK)
SETASMB6682 SEAT BACK,ASSY,SYNERGY STANDARD BACK,29''W,22"H,W/CUSHION,(29"W X 18"H BACK)
SETASMB6525 SEAT BACK,ASSY,SYNERGY STANDARD BACK,29''W,23"H,W/CUSHION,(29"W X 20"H BACK)
Page 4 of 5
Option Name MSRP Part Number Manufacturer Extended DescriptionSection Name
Quantum 1450 Cross Reference Spreadsheet - TRU-Balance Bariatric Power Tilt
SETASMB6701 SEAT BACK,ASSY,SYNERGY STANDARD BACK,29''W,24"H,W/CUSHION,(29"W X 20"H BACK)
SETASMB6544 SEAT BACK,ASSY,SYNERGY STANDARD BACK,29''W,25"H,W/CUSHION,(29"W X 22"H BACK)
SETASMB6488 SEAT BACK,ASSY,SYNERGY STANDARD BACK,30''W,19"H,W/CUSHION,(30"W X 16"H BACK)
SETASMB6664 SEAT BACK,ASSY,SYNERGY STANDARD BACK,30''W,20"H,W/CUSHION,(30"W X 16"H BACK)
SETASMB6507 SEAT BACK,ASSY,SYNERGY STANDARD BACK,30''W,21"H,W/CUSHION,(30"W X 18"H BACK)
SETASMB6683 SEAT BACK,ASSY,SYNERGY STANDARD BACK,30''W,22"H,W/CUSHION,(30"W X 18"H BACK)
SETASMB6526 SEAT BACK,ASSY,SYNERGY STANDARD BACK,30''W,23"H,W/CUSHION,(30"W X 20"H BACK)
SETASMB6702 SEAT BACK,ASSY,SYNERGY STANDARD BACK,30''W,24"H,W/CUSHION,(30"W X 20"H BACK)
SETASMB6545 SEAT BACK,ASSY,SYNERGY STANDARD BACK,30''W,25"H,W/CUSHION,(30"W X 22"H BACK)
SETASMB6489 SEAT BACK,ASSY,SYNERGY STANDARD BACK,31''W,19"H,W/CUSHION,(31"W X 16"H BACK)
SETASMB6665 SEAT BACK,ASSY,SYNERGY STANDARD BACK,31''W,20"H,W/CUSHION,(31"W X 16"H BACK)
SETASMB6508 SEAT BACK,ASSY,SYNERGY STANDARD BACK,31''W,21"H,W/CUSHION,(31"W X 18"H BACK)
SETASMB6684 SEAT BACK,ASSY,SYNERGY STANDARD BACK,31''W,22"H,W/CUSHION,(31"W X 18"H BACK)
SETASMB6527 SEAT BACK,ASSY,SYNERGY STANDARD BACK,31''W,23"H,W/CUSHION,(31"W X 20"H BACK)
SETASMB6703 SEAT BACK,ASSY,SYNERGY STANDARD BACK,31''W,24"H,W/CUSHION,(31"W X 20"H BACK)
SETASMB6546 SEAT BACK,ASSY,SYNERGY STANDARD BACK,31''W,25"H,W/CUSHION,(31"W X 22"H BACK)
SETASMB6490 SEAT BACK,ASSY,SYNERGY STANDARD BACK,32''W,19"H,W/CUSHION,(32"W X 16"H BACK)
SETASMB6666 SEAT BACK,ASSY,SYNERGY STANDARD BACK,32''W,20"H,W/CUSHION,(32"W X 16"H BACK)
SETASMB6509 SEAT BACK,ASSY,SYNERGY STANDARD BACK,32''W,21"H,W/CUSHION,(32"W X 18"H BACK)
SETASMB6685 SEAT BACK,ASSY,SYNERGY STANDARD BACK,32''W,22"H,W/CUSHION,(32"W X 18"H BACK)
SETASMB6528 SEAT BACK,ASSY,SYNERGY STANDARD BACK,32''W,23"H,W/CUSHION,(32"W X 20"H BACK)
SETASMB6704 SEAT BACK,ASSY,SYNERGY STANDARD BACK,32''W,24"H,W/CUSHION,(32"W X 20"H BACK)
SETASMB6547 SEAT BACK,ASSY,SYNERGY STANDARD BACK,32''W,25"H,W/CUSHION,(32"W X 22"H BACK)
Page 5 of 5