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Company: ________________________________________________
Account Number: __________________ Date: _________________
q Quote q PO Number: ___________________________________
RTS: _____________________________________________________
Marked For: _______________________________________________
Ship To: __________________________________________________
Address: _________________________________________________
City: ________________________________ State: _____________
Zip: ________________ Phone: _____________________________
Email/Fax: ________________________________________________
Select box corresponding to desired Frame Width
Frame Width
q 10 q 11 q 12 q 13 q 14 q 15 q 16 q 17 q 18
Phone (800) 981-1540 | Fax (715) [email protected] | www.kimobility.com
DCN0129.16 Pricing and specifications subject to change without notice Page 1 of 6
Frame
Frame Width
Frame Depth
Transit Option
q Transit System ____________________________________________________________________________________ N/C
Offset Hanger Option
q Offset Hanger ______________________________________________________________________________________ $30Available only with Rigid Base
Tilt Mechanism
q Hand ______________________________________________________________________________________________________ N/Cq Foot ________________________________________________________________________________________________________ N/C
q Little Wave Flip XP-Rigid Base E1233, E1161 ______ $2750165 lb weight capacity. Price includes one time free growth kit.Tilt range: 0º - 45º. Maximum Seat Width of 18”.
q Little Wave Flip XP-Folding Base E1234, E1161 __ $2900165 lb weight capacity. Price includes one time free growth kit.Tilt range: 0º - 45º. Maximum Seat Width of 18”.
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.
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Seat Pan
q Growing Solid Seat Pan E2231 ____________________________________________________ $175
Select Frame Depth within desired Frame Depth Range
Frame DepthRange
Frame Depth
Short12” - 16
q 12 q 13 q 14 q 15 q 16
N/C N/C N/C N/C N/C
Medium14” - 18”
q 14 q 15 q 16 q 17 q 18
N/C N/C N/C N/C N/C
Long16” - 20”
q 16 q 17 q 18 q 19 q 20
N/C N/C N/C N/C $605
E2203
Backrest
Select Back Height in row corresponding to desired Back Post and Height Range
Back Post Price Height Range
Back Height
Stroller HandleBack Post (Folding) N/C
Short q 20
Tall q 24
Fixed Height with 1
Adjustable Handle (Folding)N/C
Short q 22
Tall q 26
Adjustable Height withAdjustable Handle (Folding) $25
Short 1 q 18 q 19 q 20 q 21 q 22 q 23 q 24 q 25
Tall q 20 1 q 21 1 q 22 1 q 23 q 24 q 25 q 26 q 27
Reclining Back with 1,2,3
Adjustable Handle
(Non-Folding) E1225$885
Short q 22
Tall q 261 Not available with Seating Dynamics Rocker Back2 Available only with Attendant Foot Lock. Not available with Rigidizer Bar.3 Minimum Seat Height of 15” with 12” Mag wheel and 16” with 16” Mag wheel
Back Post / Height Range / Back Height
Effective 02/17/2020
Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0129.16 Pricing and specifications subject to change without noticePage 2 of 6
Footrest
Hanger
q 60º __________________________________________________________________________________________________________ N/CAvailable only with Extension Tube Hangers
q 70º __________________________________________________________________________________________________________ N/Cq 80º __________________________________________________________________________________________________________ N/C
Not available with 8” Casters
q 90º __________________________________________________________________________________________________________ N/CAvailable only with Front Mount Hangers. Not available with 8” Casters.
q Pediatric Pro Elevating Leg Rests (Peds PRO ELR) E0990 ____________ $295q Pro Elevating Leg Rests (PRO ELR) E0990 ______________________________ $295
Not available with Frame Widths less than 14” without Offset Hangers or Frame Widths less than 12” with Offset Hangers
Contracture Footrest K0108 _________________________________________________________________ $350Aluminum Angle Adjustable footplates included. See image below.
q Bilateral Mount q Center Mount
q Omit Hangers ___________________________________________________________________________________ - $20
FootplateNo selection needed with Contracture Footrest
q Composite ____________________________________________________________________________________________ N/CNot available with Front Mount Hanger, Frame Widths less than 14” without Offset Hangers, Frame Widths less than 12” with Offset Hanger or PRO ELR
q Composite Angle Adjustable K0040 ___________________________________________ $185Not available with Front Mount Hanger or 10”-12” Frame Widths. 13” and 14” Frame Widths require 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, Frame Widths less than 14” without Offset Hanger or Frame Widths less than 12” with Offset Hanger
Footrest / Extension / Seat to Footrest Length
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. Provided as parts.
q 3” Extension for Front Mount Hanger __________________________________________ $55
Select 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)
Short q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5
Medium q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 q 15.5
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 for $55
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
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
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
Short q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5
Medium q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5
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
Low Pivot q 6 3 q 6.5 3 q 7 4 q 7.5 4 q 8 4 q 8.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5
High Pivot q 4.5 3 q 5 3 q 5.5 4 q 6 4 q 6.5 4 q 7 q 7.5 q 8 q 8.5 q 9 q 9.5 q 10
PRO ELR Low Pivot Setting
Short q 10.5 - 15.5
Long q 13 - 19
PRO ELR High Pivot Setting
Short q 8.5 - 17
Long q 11.5 - 17.51 See Minimum Front Seat Height chart below.2 Comes standard with 3” Extension3 Not available on chairs 13” wide or more4 Not available on chairs 15” wide or more
Bilateral Mount Center Mount
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 Seating Dynamics Rocker Back
q Seating Dynamics Rocker Back K0108 __________________________________ $1995Not available with Flip Up Armrests. Available only with Non Folding Back.
q Adjustable Height Rigidizer Bar ______________________________________________________ $75
Backrest continued
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0129.16 Pricing and specifications subject to change without notice Page 3 of 6
Residual Limb SupportHeel LoopNot available with One Piece Flip Up Angle Adjustable Footplates, Frame Widths less than 14” without Offset Hangers or Frame Widths less than 12” with Offset Hangers
q Heel Loops E0951 ______________________________________________________________________________ $40q Adjustable Heel Loops E0951 ________________________________________________________ $50q Omit Heel Loops ________________________________________________________________________________ N/C
Calf Strap
q Velcro Adjustable K0038 ___________________________________________________________________ $40q Padded Velcro Adjustable K0038 __________________________________________________ $68q Bodypoint Padded AeroMesh K0038 _________________________________________ $102
Footrest continued
Hanger Release
q Classic ____________________________________________________________________________________________________ Stdq 4-Way - In line _____________________________________________________________________________________ N/C
See reference A to the right. Allows chair to be folded without removing footrest hanger. Not available with PRO ELR or Peds PRO ELR.
q 4-Way - Out _________________________________________________________________________________________ N/CSee reference B to the right. Not available with PRO ELR or Peds PRO ELR.
A B
No selection needed with Contracture Footrest. If no selection is made 4-Way - In line will be used.
Residual Limb Support E1020
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
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0129.16 Pricing and specifications subject to change without notice Page 4 of 6
Select Seat Height corresponding to desired Rear Wheel and Caster Size
Seat Height, Casters and Rear Wheels
Seat Height / Caster Size / Rear Wheel Size
RearWheelSize
Caster Size
5” 6” 6” x 2” 7” 8” 8” x 1.5”
Seat Height
12”withPneumaticor Pneumatic with AirlessInsert Tire
q 13.5
q 14 q 14 4 q 14 4
q 14.5 q 14.5 q 14.5
q 15 q 15 q 15 q 15 4
q 15.5 q 15.5 q 15.5 q 15.5 q 15.5
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 3 q 17 3 q 17
q 17.5 q 17.5 q 17.5 q 17.5 q 17.5 q 17.5
12”withFull PolyTire
q 13.5
q 14
q 14.5 q 14.5 q 14.5
q 15 q 15 q 15
q 15.5 q 15.5 q 15.5 q 15.5 q 15.5
q 16 q 16 q 16 q 16 q 16 4 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 3 q 17 3 q 17
16”withPneumatic,Pneumatic with AirlessInsert or Full PolyTire
q 15 q 15 q 15 q 15 4
q 15.5 q 15.5 q 15.5 q 15.5 q 15.5
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 4 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 2 q 19.5 4 q 19.5 4
16”withLow PolyTire
q 14 q 14 4 q 14 4
q 14.5 q 14.5 q 14.5
q 15 q 15 q 15
q 15.5 q 15.5 q 15.5 q 15.5 q 15.54
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 181 Self Propel Axle Plate selections limit tilt range2 Not available with 12” Frame Depth3 Not available with 12-16” Frame Depth4 Not available with 17-20” Frame Depth5 Not available in combination with MAXX Performance wheel and Full Poly tire6 Not available in combination with MAXX Performance wheel, Full Poly tire and 17-20” Frame Depth7 Not available in combination with Mag wheel and 17-20” Frame Depth8 Not available in combination with MAXX Performance wheel, Pneumatic tires and 17-20” Frame Depth9 17-20” Frame Depth requires MAXX Performance wheel and Full Poly tire
RearWheelSize
Caster Size
5” 6” 6” x 2” 7” 8” 8” x 1.5”
Seat Height
16”Drum Brake
q 15 q 15 q 15
q 15.5 q 15.5 q 15.5 q 15.5 q 15.5
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 17.53 q 17.5
q 18 q 18 q 18 q 18 q 18 q 18
q 18.5 4 q 18.5 q 18.5 4 q 18.5 4 q 18.5 q 18.52
q 19 q 19 q 19 q 19 q 19 q 19
20”
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 4 q 20 4 q 20 q 20 q 20
20” 1
Self Propel
q 15.5 q 15.5 q 15.5 q 15.5 q 15.5
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 18.54 q 18.5 q 18.5 q 18.54 q 18.5 q 18.52
22” 1
SelfPropel
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 4 q 19.5 2 q 19.5 4 q 19.5 4
24” 1
Self Propel
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
q19.57,8 q 19.5 q 19.5 q 19.5 9 q19.57,8 q 19.5
q 20 5 q 20 6 q 20 6 q 20 q 20 q 20
Rear Wheel Type
q Mag (Black) __________________________________________________________________________________________ N/C
Colored Mag ____________________________________________________________________________________________ $100Available only in 20” and 22” wheel sizes
Color: q Florescent Red q White q Blue q Pink
q MAXX Performance Spoke ___________________________________________________________ $200Not available in 12” or 16” wheel sizes
Rear Tire Type
q Full Poly E2218 _____________________________________________________________________________________ N/Cq Low Poly E2218 ___________________________________________________________________________________ N/C
Available only with 16” wheel size
q Pneumatic E2211, E2212 ____________________________________________________________________ $85q Pneumatic with Airless Insert E2211, E2213 _________________________________ $85
Handrim OptionNot available on Plastic Coated or Projection Handrims
q 3M Micro Grip _____________________________________________________________________________________ $65
Axle
Caster Type
q .75” Lighted Rollerblade __________________________________________________________________ $70Available only with 5" Caster Size
q 1” Poly ___________________________________________________________________________________________________ N/Cq 1” Poly Aluminum _____________________________________________________________________________ $110
Available only with 5” Caster Size
q 1” Pneumatic _______________________________________________________________________________________ $85Available only with 6” and 8” Caster Sizes
q 1.5” Poly _______________________________________________________________________________________________ $85Not available with 7” Caster Size
q 1.5” Soft Roll Aluminum _________________________________________________________________ $175Available only with 5” and 6” Caster Sizes
q 2” Poly ___________________________________________________________________________________________________ $90Available only with 6” Caster Size
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Seat Height, Casters and Rear Wheels continued
DCN0129.16 Pricing and specifications subject to change without notice Page 5 of 6
Wheel Locks
Wheel Lock
Handrim
q Aluminum Anodized ___________________________________________________________________________ Stdq Plastic Coated ___________________________________________________________________________________ $115q Projection (8 Vertical Projections) ________________________________________________ $295
Available only with full profile tires in combination with 22”-24” MAXX Performance or 24” Mag wheel
q Omit Handrims ____________________________________________________________________________________ N/C
Not available on 20” wheel size or 22” Mag wheel. Not recommended with Mag wheel.
q Natural Fit LT Regular Grip ____________________________________________________________ $465q Natural Fit Standard Regular Grip _______________________________________________ $445q Natural Fit LT Super Grip _______________________________________________________________ $515q Natural Fit Standard Super Grip __________________________________________________ $495q Natural Fit LT Omit Grip _________________________________________________________________ $395q Natural Fit Standard Omit Grip ____________________________________________________ $345
Natural Fit Handrims
Handrims not available on 12” or 16” wheel sizesStandard Handrims
q Push to Lock ________________________________________________________________________________________ StdRear wheels must be removed to fold chair with this wheel lock selection.
q Pull to Lock __________________________________________________________________________________________ N/CNot available with 12” or 16” Full Poly tires. Rear wheels must be removed to fold chair with this wheel lock selection.
q Attendant Foot Lock _________________________________________________________________________ N/CAvailable only with 12” and 16” Mag wheels.
q Drum Brake E2228 _______________________________________________________________________ $1200Not available with Hand Tilt Mechanism, 16” Low Poly tire or Stroller Handle Extension. Available only with 16” wheel size. 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
Dual - Attendant Foot Lock ___________________________________________________________________ $70Available only with 12” and 16” Mag wheels. Rear wheels must be removed to fold chair with this wheel lock selection.
q Push to Lock q Pull to Lock
Dual - Drum Brake ______________________________________________________________________________ $1270Not available with Hand Tilt Mechanism, 16” Low Poly tire or Stroller Handle Extension. Available only with 16” wheel size. Axle is Quick Release. Rear wheels must be removed to fold chair with this wheel lock selection.
q Push to Lock q Pull to Lock
No selection needed with Drum Brake
q Fixed ______________________________________________________________________________________________________ N/CNot available with Folding Base Frame and Standard Wheel Locks
q Quick Release _____________________________________________________________________________________ N/C
Armrests Please select Arm Pad option
q Height Adjustable Pediatric Desk (6.5”- 9”) E0973 _____________________ $185Best fit with Frame Depths less than 14”
q Height Adjustable Pediatric Desk Tall (8”-10.5”) E0973 _____________ $185Best fit with Frame Depths less than 14”
q Height Adjustable T-Arm (9.25”-14.25”) E0973 ______________________________ $265Not available with 12” Frame Depth
q Height Adjustable T-Arm Low (7.5”-11.5”) E0973 ________________________ $265Not available with 12” Frame Depth
q Angle Adj. Locking Extendable Flip Up (9.5”-15”) E0973 __________ $265Not available with Seating Dynamics Rocker Back
Armrests
Arm Pad
Armrests Continued
q Tubular Flip Up ____________________________________________________________________________________ N/CNot available with Seating Dynamics Rocker Back
q Omit Armrests _____________________________________________________________________________________ N/C
Arm Pads not available with Tubular Flip Up Armrest. Full Arm Pad not available with Height Adjustable Pediatric Desk Armrests.
Standard Arm Pad __________________________________ N/C q Desk q FullWaterfall Arm Pad ____________________________________ $25 q Desk q Full
Not available with Angle Adjustable Locking Flip Up Extendable armrests
Foam Grip __________________________________________________ N/C q Desk q FullAvailable only with Angle Adjustable Locking Extendable Flip Up Armrest
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Removable Side GuardNot available with Height Adjustable Armrests
q Adult Composite Side Guards (14” - 16”) K0108 ________________________ $140q Pediatric Composite Side Guards (10” - 14”) K0108 _________________ $140
Accessories
Anti-Tip
q Rear Anti-Tips E0971 _______________________________________________________________________ $140
Color
Positioning Belt
Other Accessories
q Tool Kit ___________________________________________________________________________________________________ $55q Removable Underseat Pouch ________________________________________________________ $50q Pediatric Ki Mobility Backpack ______________________________________________________ $65q Ki Mobility Backpack ________________________________________________________________________ $65q Black Neoprene Impact Guards ____________________________________________________ $90q Tilt Stop Posterior (Pair) K0108 _______________________________________________________ $30q Tilt Stop Anterior (Pair) K0108 _________________________________________________________ $30
Available only with Rigid Base
q IV Pole _________________________________________________________________________________________________ $275q Canopy with Hardware K0108 ______________________________________________________ $280
See image below
Belt Mounting Kit
q Bodypoint 1” Band Clamp Belt Mounting Kit _________________________ $105
q Seat Belt Mounting Hardware _______________________________________________________ $30
DCN0129.16 Pricing and specifications subject to change without notice Page 6 of 6
q 1” Auto Buckle E0978 _______________________________________________________________________ $70q 1” Padded Auto Buckle E0978 _____________________________________________________ $155q 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”)
Spoke Guards
q Clear Spoke Guards K0065 ___________________________________________________________ $115Not available with Mag wheel
q Black Spoke Guards K0065 __________________________________________________________ $115Available only with 22” and 24” Spoke wheels
Designer Spoke Guards K0065 __________________________________________________________ $200Available only with 20” and 22” wheel sizes. Not available with Mag wheel.
Design:
q Blue Monster q Fairy Garden q Havin’ a Hoot
q Robo Fun q Rockin’ Reptiles q Super Puppies
q Tutu Cute q Tuxedo Time
Matte Finish Charcoal Gray __________________________________________________ N/CEmerald Green _________________________________________________ N/CIridescent Burgundy _______________________________________ N/CIridescent Navy _________________________________________________ N/C Military Green ____________________________________________________ N/CRetro Red ___________________________________________________________ N/CRoyal Blue __________________________________________________________ N/CShadow Black __________________________________________________ N/CSmooth White ___________________________________________________ N/C
Frame Accentq qq qq qq qq qq qq qq qq q
Gloss Finish Black ____________________________________________________________________ N/CBlue Skies __________________________________________________________ N/CBubblegum Pink ______________________________________________ N/CCandy Blue ________________________________________________________ N/CCandy Purple ____________________________________________________ N/CCandy Red _________________________________________________________ N/CCopper ________________________________________________________________ N/CGranny Smith ____________________________________________________ N/CMetallic Fuchsia ________________________________________________ N/CMetallic Orange ________________________________________________ N/CSilver ____________________________________________________________________ N/CTeal _______________________________________________________________________ N/CYellow __________________________________________________________________ N/C
Frame Accentq qq qq qq qq qq qq qq qq qq qq qq qq q
Frame and AccentSelect desired frame and accent colors. Accent color is used on side panel; if no accent color is selected, frame color will be used.
Canopy Height Above Hardware
14”
Hardware mounts on vertical part of back cane.
DCN0537.0 Pricing and specifications subject to change without notice Page 1 of 1
Width
14” 15” 16” 17” 18” 19” 20” 21” 22”
Dep
th
14” q15” q q q16” q q q q q q q17” q q q q q q q18” q q q q q q q q19” q q q q q q q20” q q q q q q q21” q q q q q22” q q q q q
Width
14” 15” 16” 17” 18” 19” 20” 21” 22”D
epth
14” q q q15” q q q q q16” q q q q q q q q17” q q q q q q q q18” q q q q q q q q q19” q q q q q q q q q20” q q q q q q q q q21” q q q q q q q q22” q q q q q q q q
Width
14” 15” 16” 17” 18” 19” 20” 21” 22”
Dep
th
14” q q q15” q q q q16” q q q q q q q q17” q q q q q q q q18” q q q q q q q q q19” q q q q q q q q q20” q q q q q q q q q21” q q q q q q q q22” q q q q q q q q
q Axiom G E2601 __________________________________________________________________________________ $120q Axiom S E2603 __________________________________________________________________________________ $210q Axiom P E2605 __________________________________________________________________________________ $355
q Axiom G E2602 __________________________________________________________________________________ $199q Axiom S E2604 __________________________________________________________________________________ $315q Axiom P E2606 __________________________________________________________________________________ $460
q Axiom SP - Visco E2607 _________________________________________________________________ $430q Axiom SP - Fluid E2607 __________________________________________________________________ $470
q Axiom SP - Visco E2608 _________________________________________________________________ $525q Axiom SP - Fluid E2608 __________________________________________________________________ $575
q Axiom G Extra Outer Cover ____________________________________________________________ $75q Axiom S Extra Outer Cover _____________________________________________________________ $85q Axiom P Extra Outer Cover _____________________________________________________________ $95q Axiom SP Extra Visco Outer Cover ____________________________________________ $105q Axiom SP Extra Fluid Outer Cover _____________________________________________ $105
q Axiom SP Extra Visco Inner Cover _____________________________________________ $105q Axiom SP Extra Fluid Inner Cover _______________________________________________ $105
Select size in chart below. Weight capacity: 350 lbs.
Solid Seat Insert ________________________________________________________________________________________ $60
Inner Cover Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Outer Cover Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Solid Seat Insert Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Axiom SP Cushion Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Axiom G, S or P Cushion Quantity: q 1 q 2If no selection is made, quantity 1 will be selected
Axiom G, S and P Cushions
Cushions Under 22” Wide
Outer Covers
22” Wide Cushions
Axiom SP Cushions
Cushions Under 22” Wide
22” Wide Cushions
Axiom Cushion Accessories
Solid Seat Insert
Inner Covers
Select size in chart at right. Weight capacity: 350 lbs.
Select size in chart at right. Weight capacity: 350 lbs.
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
DCN0538.1 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
DCN0538.1 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
DCN0538.1 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
DCN0538.1 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
DCN0538.1 Pricing and specifications subject to change without notice Page 5 of 5
Axiom Back Accessories continued
Selection of a modification from the Axiom Back Modifications section required in order to mount posture supports. Not available with Low Backs.
Description Item Code HCPC Retail
q Small Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60153T E0960 $144
q Medium Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60154T E0960 $144
q Large Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60155T E0960 $144
q Small Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60110T E0960 $113
q Medium Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60111T E0960 $113
q Large Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60112T E0960 $113
q Small Dynamic Therafit Comfortfit Full Vest 30589T E0960 $167
q Medum Dynamic Therafit Comfortfit Full Vest 30590T E0960 $167
q Large Dynamic Therafit Comfortfit Full Vest 30591T E0960 $167
q XLarge Dynamic Therafit Comfortfit Full Vest 30592T E0960 $167
q XXLarge Dynamic Therafit Comfortfit Full Vest 30593T E0960 $167
q Small Dynamic Therafit Comfortfit Trim Vest 30618T E0960 $169
q Medum Dynamic Therafit Comfortfit Trim Vest 30619T E0960 $169
q Large Dynamic Therafit Comfortfit Trim Vest 30620T E0960 $169
q XLarge Dynamic Therafit Comfortfit Trim Vest 30621T E0960 $169
q XXLarge Dynamic Therafit Comfortfit Trim Vest 30622T E0960 $169
Therafin Posture Support
Choose modification to add holes to the back shell in order to mount posture supports. Not available with Low Backs.
Description Item Code HCPC Retail
q Modification for 4 Point Harness AXM4PT K0108 N/C
q Modification for 2 Point Chest Strap AXM2PT K0108 N/C
q Modification for Shoulder GuidesIncludes shoulder guides
AXMSG K0108 $50
Axiom Back Modifications
Gloss Finish Item Code Retail
q Black AXMBLK N/C
q Blue Skies AXMSKY N/C
q Bubblegum Pink AXMPNK N/C
q Candy Blue AXMCBL N/C
q Candy Purple AXMPUR N/C
q Candy Red AXMRED N/C
q Copper AXMCOP N/C
q Granny Smith AXMGSM N/C
q Metallic Fuchsia AXMMTF N/C
q Metallic Orange AXMMOR N/C
q Silver AXMSIL N/C
q Teal AXMTEA N/C
q Yellow AXMYLW N/C
Painted Back Shell ModificationIf no selection is made, standard Shadow Black will be used with no additional lead time
Axiom Back Modifications Extended lead times will apply for all modifications
Phone (800) 981-1540 | Fax (715) 254-0996
[email protected] | www.kimobility.com
Matte Finish Item Code Retail
q Charcoal Gray AXMCGM N/C
q Emerald Green AXMEGM N/C
q Iridescent Burgundy AXMIBM N/C
q Iridescent Navy AXMINM N/C
q Military Green AXMAGM N/C
q Retro Red AXMRRM N/C
q Royal Blue AXMRBM N/C
q Smooth White AXMSWM N/C
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