qqqqqqqqq q - Ki Mobility · 2020-02-11 · Chair will ship from Ki Mobility with adaption kit...

Company: ________________________________________________

Account Number: __________________ Date: _________________

q Quote q PO Number: ___________________________________

RTS: _____________________________________________________

Marked For: _______________________________________________

Ship To: __________________________________________________

Address: _________________________________________________

City: ________________________________ State: _____________

Zip: ________________ Phone: _____________________________

Email/Fax: ________________________________________________

Frame

Seat Width / Seat DepthSelect box corresponding to desired Seat Width and Depth

Seat Width

14” 15” 16” 17” 18” 19” 20” 21” 22”

PriceHCPCS

N/C N/C N/C N/C N/C N/C$500E2201

$500E2201

$500E2201

Sea

t D

epth

14” N/C q q q q q q q q q15” $90 q q q q q q q q q16” N/C q q q q q q q q q17” $90 q q q q q q q q q18” N/C q q q q q q q q q19” N/C q q q q q q q q q20” $500

E2203 q q q q q q q q q

Transit Option

q Transit System __________________________________________________________________________________ $320Not available with Removable Seat Pan or Heavy Duty Option

Heavy Duty Option

q 350 lb Weight Capacity __________________________________________________________________ $500Requires minimum 6” caster height

Cross Brace

q Standard Cross Braces _____________________________________________________________________ Stdq Seating System Cross Braces _______________________________________________________ N/C

Allows for easy attachment of seating system mounting hardware. Not available with Seat Sling.

Catalyst 5Vx K0005 ____________________________________________________________________ $1895300 lb weight capacity

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

Wheelchair Drive ReadyChair will ship from Ki Mobility with adaption kit installed for selected Alber system. Order system separately from Alber USA. Select Rear Seat Height (full profile selections only) in drive wheel size on Rear Seat Height chart (page 5). Requires Rear Anti-Tips. Not available with Height Adjustable Flip Back T-Arm.

q e-motion Ready __________________________________________________________________________________ N/Cq twion Ready _________________________________________________________________________________________ N/C

Seat Option

q Removable Aluminum Seat Pan E2231 _____________________________________ $265Not available with Transit System. Pan depth 1/2” shorter than Seat Depth.

DCN0014.32 Pricing and specifications subject to change without notice of 8

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.

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

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


Back Upholstery

Military Patch

Footrest

Hanger / Front Frame Bend

q 60º __________________________________________________________________________________________________________ N/CAvailable only with Extension Tube Hangers

q 70º __________________________________________________________________________________________________________ N/Cq 80º __________________________________________________________________________________________________________ N/C

Not available with 7” or 8” Casters

q 90º __________________________________________________________________________________________________________ N/CAvailable only with Front Mount Hangers. Not available with 7” or 8” Casters.

q Pro Elevating Leg Rests (PRO ELR) E0990 _______________________________ $295q Omit Hangers ___________________________________________________________________________________ - $20

Footplate

q Composite ____________________________________________________________________________________________ N/CNot available with Front Mount Hanger or PRO ELR

q Composite Angle Adjustable K0040 ___________________________________________ $185Not available with Front Mount Hanger or 14” Seat Width

q Aluminum Angle Adjustable K0040 _____________________________________________ $185q One Piece Flip Up Angle Adjustable K0040 ______________________________ $190

Not available with Front Mount Hanger or PRO ELR

Backrest

Back Post / Height Range / Back HeightSelect Back Height in row corresponding to desired Back Post and Height Range

BackPost

Price Height Range

Back Height

Standard N/C

Short q 8.5 q 9.5 q 10.5 q 11.5

Medium q 12.5 q 13.5 q 14.5 q 15.5

Tall q 16.5 q 17.5 q 18.5 q 19.5

Angle Adjustable w/ Push Handle

$185

Short q 14 q 15 q 16

Medium q 16 q 17 q 18

Tall q 18 q 19 q 20

Standard Back PostSelect option below only if a Standard Back Post option is selected on chart above

q Straight with Push Handle ________________________________________________________________ Stdq Straight without Push Handle ________________________________________________________ N/Cq 8º Bend with Push Handle ______________________________________________________________ $25

Not available with Short Back Height Range

q Straight with Fold Down Push Handle ______________________________________ $125Not available with Heavy Duty option

Push Handle OptionsNot available with Straight Back Post with Fold Down Push Handle or Heavy Duty Option

q Low Profile Push Handle _________________________________________________________________ $652” shorter than standard push handles

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

q Standard ________________________________________________________________________________________________ StdNot available with Short or Medium Back Height Ranges on 20” - 22” Seat Widths

Tension Adjustable E2611

q Standard Cover _____________________________ $315 q Air Mesh Breathable Cover ____________________ $390

q Omit Back Upholstery ___________________________________________________________________ - $15

Attached only if ordered with Tension Adjustable Back Upholstery

US Military Service Patch _______________________________________________________________________ $90 q Army q Navy q Marines q Air Force q Coast Guard

q US Purple Heart Patch _____________________________________________________________________ $90

Purple Heart with Military Service Patch Combo __________________________ $145 q Army q Navy q Marines q Air Force q Coast Guard

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



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

Footrest Extension Seat to Footrest Length

Extension TubeHangers(60º, 70º, 80º)

Short q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15

Medium q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17

Long q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5

Front Mount Hangers 1

Standard Selections Requires 3” Extension for $35

Short(70º, 80º, 90º)

q 5 q 5.5 q 6 q 6.5 q 7 q 10 q 10.5 q 11

q 7.5 q 8 q 8.5 q 9 q 9.5 q 11.5 q 12 q 12.5

Medium(70º, 80º, 90º)

q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 12 q 12.5 q 13

q 8.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5 q 13.5 q 14 q 14.5

Long(70º, 80º)

q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 8.5 q 9 q 14 q 14.5 q 15

q 9.5 q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 15.5 q 16 q 16.5

PRO ELR Low Pivot Setting

Short q 12 - 17.5

Long q 15 - 21

PRO ELR High Pivot Setting

Short q 10.5 - 15.5

Long q 13 - 19

Fixed Front Frame(70º, 80º)

Short q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15

Medium q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17

Long q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.51 See Minimum Front Seat Height chart below.

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

13.5” 13.5” 14” 15” 16” 17”

Minimum Front Seat Height with 3” Extension

14.5” 16” 16.5” 18” 18.5” 20”

3” ExtensionAvailable only with Front Mount Hangers. Provided as parts.

q 3” Extension for Front Mount Hanger __________________________________________ $35

Footrest continued

Hanger ReleaseIf no selection is made Classic Hanger Release will be used

q Classic ____________________________________________________________________________________________________ Stdq 4-Way - In line _____________________________________________________________________________________ N/C

See reference A to the right. Not available with PRO ELR.

q 4-Way - Out _________________________________________________________________________________________ N/CSee reference B to the right. Not available with PRO ELR.

A B

Residual Limb Support

Heel Loop

Calf Strap

q Velcro Adjustable K0038 ___________________________________________________________________ $40q Padded Velcro Adjustable K0038 __________________________________________________ $68q Bodypoint Padded AeroMesh K0038 _________________________________________ $102

Not available with One Piece Flip Up Angle Adjustable Footplate

q Heel Loops E0951 ______________________________________________________________________________ $30q Adjustable Heel Loops E0951 ________________________________________________________ $50q Omit Heel Loops ________________________________________________________________________________ N/C

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

Front Seat Height and Casters

Caster Type

q .75” Rollerblade __________________________________________________________________________________ N/CAvailable only with 4” Caster Size

q .75” Lighted Rollerblade __________________________________________________________________ $70Available only with 4” Caster Size

q 1” Poly ___________________________________________________________________________________________________ N/Cq 1” Poly Aluminum _____________________________________________________________________________ $160

Available only with 4” and 5” Caster Sizes

q 1” Pneumatic _______________________________________________________________________________________ $85Available only with 6” and 8” Caster Sizes

q 1.5” Poly _______________________________________________________________________________________________ $50Not available with 7” and 8” Caster Sizes

q 1.5” Soft Roll Aluminum _________________________________________________________________ $175Not available with 7” and 8” Caster Sizes

q 2” Poly ___________________________________________________________________________________________________ $70Available only with 6” Caster Size

q 2” Pneumatic w/ Foam Insert ______________________________________________________ $225Available only with 8” Caster Size

Caster Size / Front Frame Type / Front Seat Height

Fork Options

Fork Stem

q Best Fit ___________________________________________________________________________________________________ StdKi Mobility will pick Fork and Stem combination to optimize performance based on Caster Size and Front Seat Height

q Standard Fork Stem __________________________________________________________________________ N/Cq 3/4” Longer Fork Stem ____________________________________________________________________ N/Cq 1 1/2” Longer Fork Stem _________________________________________________________________ N/C

q Frog Legs Ultra-Sport Fork - Black ____________________________________________ $425Available only with 4”, 5” or 6” Caster Sizes. Not available with Caster Pin Locks, Heavy Duty Option, 2” Poly caster or 2” Pneumatic w/ Foam Insert caster.

End User Weight Required: ____________ lbsq Frog Legs PHASE 2 Carbon Fork ______________________________________________ $425

Lightweight shock absorbing fork. Available only with 4”, 5” or 6” Caster Sizes. Not available with Caster Pin Locks, Heavy Duty Option, 2” Poly caster or 2” Pneumatic w/ Foam Insert caster.

q Caster Pin Locks K0073 _________________________________________________________________ $195Not available with Performance Caster Housing, 1 1/2” Longer Fork Stem or Frog Legs Fork

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


Caster Housing

q Standard _______________________________________________________________________________________________ N/Cq Performance ________________________________________________________________________________________ $40

Maximum Seat Dump Reference(Front Seat Height minus Rear Seat Height)

Seat Depth 14” 15” 16” 17” 18” 19” 20”Maximum Dump Standard Caster Housing 1.5” 2” 2” 2” 2.5” 2.5” 2.5”Maximum Dump Performance Caster Housing 3” 3” 3” 3.5” 3.5” 4” 4”

Depending on configuration, chairs with Fixed Front Frame Type may achieve up to an additional .75”

Select Front Seat Height in row corresponding to desired caster size.Note: Selections in first three Front Seat Height columns use Super Low Front Frame. Super Low Front Frame not available with Fixed Front Frame.

Caster Size

Front Seat HeightUses Super Low Front Frame

4” q 13.51 q 14 q 14.5 q 152 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20

5” q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5

6” q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 21

7” q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 21

8” q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 q 211 Front Seat Height not available with 4 x 1” Poly Caster2 Super Low Front Frame required when using 4 x 1” Poly Caster


Wheel Locks

Wheel Lock Wheel Lock Options

q Push to Lock ________________________________________________________________________________________ Stdq Push to Lock Flush Mount ______________________________________________________________ N/Cq Pull to Lock __________________________________________________________________________________________ N/Cq Low Profile Scissor Lock _________________________________________________________________ $65

Not available with Low Poly, Full Poly or Sentinel Solid tires

q Short Thro Scissor Lock ________________________________________________________________ $110q Omit Wheel Locks _____________________________________________________________________________ N/C

q Extension Handles E0961 ________________________________________________________________ $70Available only with Push to Lock or Pull to Lock Wheel Locks

q Grade Aids E0974 _____________________________________________________________________________ $150Available only with Push to Lock Wheel Locks and Pneumatic or Pneumatic with Airless Insert tires

Rear Wheel Type

q Assembled 24” Six-Spoke Mag with Treaded Tireand Composite Handrim ______________________________________________________________ - $25

No substitutions available. Do not select Rear Tire Type or Handrim. Measures as Full Profile tire. Not available with Heavy Duty Option.

q 24” MAXX Performance Spoke _____________________________________________________ N/Cq MAXX Performance Spoke (20”, 22”, 25” or 26”) __________________ $200q Mag ________________________________________________________________________________________________________ N/C

Not available in 25” or 26” wheel sizes

q Superlight Spoke _____________________________________________________________________________ $295Available only in 24” and 25” wheel sizes. 25” wheel size available only with Superlight and Plastic Coated Handrims. Not available with Heavy Duty Option.

Spinergy Spox _________________________________________________________________________________________ $835Not available in 20” wheel size

Color: q Black q Red q White q Blue q Yellow Handrim:

Available only with Aluminum Anodized and Plastic Coated Handrims

q Short Tab _____________________________________________________________________ $25 q Long Tab ______________________________________________________________________ N/C

q Omit ____________________________________________________________________________________________________ - $45Omits rear wheels, tires, handrims and axles. Selection required in Wheel Size / Tire Profile / Rear Seat Height chart above.

Rear Tire Type

q Street Pneumatic 1 3/8” E2211, E2212 ___________________________________________ StdNot available on 25” wheel size

q Full Poly 1 3/8” E2218 _______________________________________________________________________ N/CNot available on Superlight wheel or 25” or 26” wheel sizes

q Pneumatic with Airless Insert 1 3/8” E2211, E2213 ____________________ $95Not available on Superlight wheel or 25” wheel size

q Schwalbe HS-127 1 3/8” E2211, E2212 ______________________________________ $125Available only on 24” wheel size. Not available on Mag wheel.

q Euro Trek Knobby 1 3/8” E2211, E2212 _________________________________________ $95Available only on 24” wheel size

q Low Poly 1” E2218 _____________________________________________________________________________ $50Not available on Superlight wheel, 25” or 26” wheel sizes or Heavy Duty Option

q Sentinel Solid Tire 1” E2218 ____________________________________________________________ $95Not available on Superlight wheel or 20” and 22” Mag wheels

q High Pressure 1” E2211, E2212 ________________________________________________________ $95Not available on Mag wheel

q Schwalbe Marathon Plus Evolution 1” E2211, E2212 ______________ $135Not available on Mag wheel, 20” or 22” wheel sizes

Full Profile

Rear Seat Height and Wheels

Wheel Size / Tire Profile / Rear Seat Height

Low Profile

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



Select Rear Seat Height in row corresponding to desired Wheel Size and Tire Profile. 14” Seat Depth not available with 24”, 25” or 26” wheel sizes.

Wheel Size Tire Profile Rear Seat Height

20”Low q 11.5” q 12.5” q 13.5” q 14.5” q 15.5” q 16.5”

Full q 12” q 13” q 14” q 15” q 16” q 17”

22”Low q 12.5” q 13.5” q 14.5” q 15.5” q 16.5” q 17.5”

Full q 13” q 14” q 15” q 16” q 17” q 18”

24”Low q 13.5” q 14.5 q 15.5” q 16.5” q 17.5” q 18.5”

Full q 14” q 15” q 16” q 17” q 18” q 19”

25” Low q 14” q 15” q 16” q 17” q 18” q 19”

26”Low q 14.5” q 15.5” q 16.5” q 17.5” q 18.5” q 19.5”

Full q 15” q 16” q 17” q 18” q 19” q 20”

Handrim

Handrim Option

q 3M Micro Grip _____________________________________________________________________________________ $65Not available on Plastic Coated or Projection Handrims

q Aluminum Anodized ___________________________________________________________________________ Stdq Superlight Aluminum Anodized _____________________________________________________ $50

Available only on 24” and 25” wheel sizes. Available only on MAXX Performance or Superlight wheels. Not available with Heavy Duty Option.

q Plastic Coated ___________________________________________________________________________________ $100q Projection (8 Vertical Projections) ________________________________________________ $310

Available only with full profile tires in combination with 22”-26” MAXX Performance Spoke, or 24” Mag wheel

q Omit Handrim ______________________________________________________________________________________ N/C

Standard Handrims 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

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



Axle

Axles

Axle Position

q Quick Release ______________________________________________________________________________________ Stdq Quad Quick Release _______________________________________________________________________ $175

Not available with Mag or Spinergy wheels

Armrest Please select Arm Pad option

q Height Adjustable T-Arm (8.5” - 13.5”) E0973 ________________________________ $275q Height Adjustable T-Arm Low (7.5” - 11.5”) E0973 ______________________ $275q Height Adjustable Flip Back T-Arm (9.5”-13.5”) E0973 _______________ $285q Flip Back (10.5”) ____________________________________________________________________________________ $50

Not available with Seat Depths less than 16” or Angle Adjustable Back Posts

q Swing Away (10.5” - 12.5”) E0973 _____________________________________________________ $210Not available with Angle Adjustable Back Posts or Arm Pads

q Swing Away with Side Guard (10.5” - 12.5”) E0973 _____________________ $285Not available with Angle Adjustable Back Posts or Arm Pads

q Omit Armrests _____________________________________________________________________________________ N/C

Arm Pad

Armrests

Armrest continued

CamberCombination of Standard and Adjustable Camber cannot exceed 4º. Selection will default to a max of 4º combined if exceeded.

Standard Camber _____________________________________________________________________________________ N/CChair will be set up with this camber selection

q 0º q 1º q 2º q 3º q 4º

Adjustable Camber __________________________________________________________________________________ N/CExtra camber spacers mounted to the inside of the rear frame for later use

q 1º q 2º q 3º q 4º

If no selection is made position 3 will be used. Position 4 is 7/8” forward of the back cane.

Center of Gravity q 1 q 2 q 3 q 4

Accessories

Not available with T-Arms, Flip Back or Swing Away with Side Guard Armrests

q Composite Side Guards K0108 ____________________________________________________ $145

Aluminum Straight K0108 New! q Black Matte _________________________________ $195 q Match Frame Color __________________________ $245

Not available with Hydrographics

Fixed Mount Fender Side Guards K0108Not available with 24” wheel size in combination with 14” Rear Seat Height

q Aluminum __________________________________ $150 q Carbon Fiber ________________________________ $475

Aluminum Adjustable Fender with Foam Pad K0108

q Black Matte _________________________________ $275 q Match Frame Color __________________________ $325

Not available with Hydrographics

q Carbon Fiber Adjustable Fender K0108 ____________________________________ $485

Removable Side Guard Anti-Tip

q Rear Anti-Tips E0971 _______________________________________________________________________ $145

Swing-In Anti-Tip E0971Not available with Heavy Duty Option

q Single - Left _________________________________ $150Not available with left side O2 Holder

q Single - Right _______________________________ $150Not available with right side O2 Holder

q Pair ________________________________________ $300Not available with Cane and Crutch Holder or O2 Holder

Not available with Swing Away Armrests

Standard Arm Pad __________________________________ N/C q Desk q FullWaterfall Arm Pad ____________________________________ $25 q Desk q Full

Available only with Height Adjustable T-Arm and Height Adjustable T-Arm Low

Accessories continued

Positioning Belt

q 1 1/2” Auto Buckle E0978 ________________________________________________________________ $70q 1 1/2” Padded Auto Buckle E0978 _____________________________________________ $155q 2” Airline Buckle E0978 ___________________________________________________________________ $110

Bodypoint Evoflex - Pelvic Stabilizer E0978 ____________________________________ $183 Size: q Small (16-24”) q Medium (19-29”) q Large (25-37”)

Bodypoint Belt Mounting Kit _______________________________________________________________ $105 Style: q Bracket q Band Clamp 1”

Other Accessories

q Tool Kit ___________________________________________________________________________________________________ $45q Removable Underseat Pouch ________________________________________________________ $50q Pediatric Ki Mobility Backpack ______________________________________________________ $50q Ki Mobility Backpack ________________________________________________________________________ $65q Luggage Carrier _________________________________________________________________________________ $85

Not available with PRO ELR or Residual Limb Support

q Black Neoprene Impact Guards ____________________________________________________ $90q Clear Spoke Guards K0065 ___________________________________________________________ $115

Not available with Mag wheel

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

q Cane and Crutch Holder _______________________________________________________________ $195q IV Pole _________________________________________________________________________________________________ $265

Available only with Standard Straight Back Posts

Step Tube ____________________________________________________________________________________________________ $40Not available with Transit Wheels or Heavy Duty Option

q Right Side q Left Side

Color

Matte Finish

Gloss Finish

q Charcoal Gray _____________________________________________________________________________________ N/Cq Emerald Green ____________________________________________________________________________________ N/Cq Iridescent Burgundy __________________________________________________________________________ N/Cq Iridescent Navy ___________________________________________________________________________________ N/C q Military Green ______________________________________________________________________________________ N/Cq Retro Red _____________________________________________________________________________________________ N/Cq Royal Blue ____________________________________________________________________________________________ N/Cq Shadow Black _____________________________________________________________________________________ N/Cq Smooth White _____________________________________________________________________________________ N/C

q Black ______________________________________________________________________________________________________ N/Cq Blue Skies ____________________________________________________________________________________________ N/Cq Bubblegum Pink _________________________________________________________________________________ N/Cq Candy Blue __________________________________________________________________________________________ N/Cq Candy Purple ______________________________________________________________________________________ N/Cq Candy Red ___________________________________________________________________________________________ N/Cq Copper __________________________________________________________________________________________________ N/Cq Granny Smith ______________________________________________________________________________________ N/Cq Metallic Fuchsia __________________________________________________________________________________ N/Cq Metallic Orange __________________________________________________________________________________ N/Cq Yellow ____________________________________________________________________________________________________ N/C

HydrographicsVisit www.kimobility.com for current Hydrographic options. Note selection below

q $695

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



O2 HolderO2 Holder E2208 ______________________________________________________________________________________ $295 q Right Side q Left Side

Transit Wheels

q Transit Wheels K0108 ______________________________________________________________________ $145Not available with Step Tube, Rear Seat Heights less than 14” or Heavy Duty Option

Colored Anodizing PackageSelect desired color. If no selection is made, black will be used.

Option Standard Caster Housing 2 Caster Fork 3 Axle Plate

Retail $75 $75 $75

Co

lor

Black 1 q q qBlue q q qBright Green q q qGold q q qOrange q q qPewter q q qPink q q qPurple q q qRed q q q

1 Black is no charge2 Available only if corresponding option selection was made3 Not available with 2” wide casters, Frog Legs Ultra-Sport or PHASE 2 Carbon

Forks

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



Catalyst Front Seat Height Matrix

4” Caster 5” Caster 6” Caster 7” Caster 8” Caster

FSHSuper Low

Stem Fork FSHSuper Low




Stem Fork

151 13.51

Std

4”

16 14.5 Std

4”

17 15.5 Std

5”

18 17Std

6”

19 18 Std

6”15.5 14 16.5 15.5 3/4 18 16.5 3/4 18.5 17.5 20 18.5 3/4

162 14.52

3/417.5 16 1 1/2 18.5 17 1 1/2 19 17.5

3/420.5 n/a 1 1/2

16.5 15 16 15Std

5”

17 16

Std

6”

19.5 18 19 17.5

Std

7”

16.52 152

1 1/216.5 15.5 17.5 16.5 19.5 18.5

1 1/219.5 18

17 15.5 17 15.53/4

18 17 20 19 20 18.5

15.5 14.5Std

5”

17.5 16 18 16.5

3/4

18.5 17.5

Std

7”

20.5 19

16 15 17.5 16.51 1/2

18.5 17 19 18 19.5 18.5

3/416.5 15

3/418 17 19 17.5 19.5 18.5 20 19

17 15.5 16.5 15.5

Std

6”

18.5 17.5

1 1/2

20 19 20.5 n/a

17 161 1/2

17 16 19 18 19 18

3/4

21 n/a

17.5 16.5 17.5 16.5 19.5 18.5 19.5 18.5 20.5 191 1/2

17 15.5Std

6”

17.5 16

3/4

18 16.5

Std

7”

20 19 21 n/a

17.5 16 18 16.5 18.5 17 20.5 n/a 8” x 2” caster not available with 6” fork17.5 16.5

3/418.5 17 19 17.5 20 18.5

1 1/218 17 18 17

1 1/2

19.5 18 20.5 19

18.5 171 1/2

18.5 17.5 18.5 17.5

3/4

21 n/a

19 17.5 19 18 19 18

18 17Std

7”

18 16.5

Std

7”

19.5 18.5

18.5 17.5 18.5 17 20 19

19 17.53/4

19 17.5 19.5 18

1 1/219.5 18 18.5 17.5

3/4

20 18.5

19.5 18.51 1/2

19 18 20.5 19

20 19 19.5 18.5 21 n/a

19.5 18

1 1/2

6” x 2” caster not available with 5” fork

20 18.5

20.5 19

1 Front Seat Height not available with 4 x 1” Poly Caster 2 Not available with 4 x 1” Poly, 4 x 1.5” Poly or 4 x 1.5” Soft Roll Aluminum

Seat heights with “FSH” heading available with Standard Front Frame. Seat heights with “Super Low” heading available with Super Low Front Frame. Actual seat height may vary depending upon configuration.

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



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


Axiom Back Select back that is the same or up to 2” narrower than the width of the frame. Hardware is included with back. Low Back selections are not available with headrests, modifications, or posture supports. Weight capacity: 300 lbs.

Width

12” 14” 16” 18” 20” 22”Retail $555 $555 $555 $555 $555 $791

HCPC E2613 E2613 E2613 E2613 E2613 E2614

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



Mid




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

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



Mid




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


Axiom Posterior Lateral Back (PL)

Axiom Posterior Back - Low Axiom Posterior Back - Mid

Axiom Posterior Back Measurement Reference

Back Height A B Shell Contour Depth

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8” 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


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8” 10” 6.5”

3.65”

10” 12” 8.5”

12” 14” 10.5”

Mid

14” 16” 8.5”

16” 18” 9.5”

18” 20” 10.5”

Tall 20” 22” 11.5”

22” 24” 12.5”Axiom Posterior Lateral

Back - LowAxiom Posterior Lateral

Back - MidAxiom Posterior Lateral

Back - Tall

A

5.5

B

5.5

AB

A

5.5

B


Width

12” 14” 16” 18” 20” 22”Retail $735 $735 $735 $735 $735 $813

HCPC E2620 E2620 E2620 E2620 E2620 E2621

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



Mid




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


Axiom Lateral Back (LB)

Axiom Back continued Select back that is the same or up to 2” narrower than the width of the frame. Hardware is included with back. Low Back selections are not available with headrests, modifications, or posture supports. Weight capacity: 300 lbs.

Axiom Lateral Back Measurement Reference


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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

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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”

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Mid

14” 16” 8.25” 8.25” 8.25” 8.25” 8.25” 8.25”

6”

16” 18” 9.25” 9.25” 9.25” 9.25” 9.25” 9.25”

18” 20” 10.25” 10.25” 10.25” 10.25” 10.25” 10.25”

Tall 20” 22” 9.5” 9.75” 10” 10.25” 10.25” 10.5”

22” 24” 10.75” 11” 11.25” 11.5” 11.5” 11.75”1 Measurement based on back width

Axiom Deep Lateral Back - Mid Axiom Deep Lateral Back - Tall

AB

7.75

AB

7.75

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


Description Item Code HCPC Retail (Each)

q Headrest Flip Down MountOnly available with HEDHMD401/HEDHMD417

HDR100 E1028 $170

q Universal Mounting PlateFor use with other manufacturer headrests

UMP K0108 $40


Axiom Back Accessories

Headrest and HardwareChoose headrest and hardware combination in chart below. Not available with Low Backs.

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


HEDHDW101/HEDHDW117 HEDHDW201/HEDHDW217 HEDHDW401/HEDHDW417

HEDPAD408

HEDPAD410

HEDPAD414

HEDPAD201

HEDPAD202

HEDPAD203

HEDPAD502

HEDPAD503

Hardware

Standard Straight Back Mount Hardware with Ball

Multi Axis Removable Hardware with Horizontal Bar

Headrest Hardware with Ball

HEDHDW101 / HEDHDW117 HEDHDW201 / HEDHDW217 HEDHDW401 / HEDHDW417

Description Item Code HCPC Kio Code Retail Kio Code Retail Kio Code Retail

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dre

st P

ad

Comfort Plus Headrest 8” HEDPAD408 E0955E1028 q HDR001 $277 q HDR009 $313 q HDR017 $388



Small All Positioning Headrest Pad and Ring Only HEDPAD201 E0955

E1028 q HDR004 $277 q HDR012 $313 q HDR020 $388

Medium All Positioning Headrest Pad and Ring Only

HEDPAD202 E0955E1028 q HDR005 $277 q HDR013 $313 q HDR021 $388

Large All Positioning Headrest Pad and Ring Only HEDPAD203 E0955

E1028 q HDR006 $277 q HDR014 $313 q HDR022 $388

Tri-Comfort Plus Headrest 14”


Tri-Comfort Plus Headrest 19”


Headrest Hardware Options


Axiom Back Accessories continued

Available only with Axiom Lateral Back and Axiom Deep Lateral back

Description Item Code HCPC Retail

q Lumbar Pad 12” L12 K0108 $48






Lumbar Pads


q Privacy Flap 12” PF12 K0108 $45






Privacy Flap

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


Lateral Support

Laterals for Posterior BackPair Left Right Description Item Code HCPC Pair Each

q q q 3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF3x4P E0956 $305 $153

q q q 4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Back LF4x5P E0956 $305 $153

q q q 3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back LS3x4P E0956, E1028 $650 $325

q q q 4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Back LS4x5P E0956, E1028 $650 $325Laterals for Posterior Lateral BackPair Left Right Description Item Code HCPC Pair Each

q q q 3 x 4 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral Back LF3x4L E0956 $305 $153

q q q 4 x 5 Lateral Pads with Fixed Mounting Hardware for Axiom Posterior Lateral Back LF4x5L E0956 $305 $153

q q q3 x 4 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral Back

LS3x4L E0956, E1028 $650 $325

q q q4 x 5 Lateral Pads with Swing Away Mounting Hardware for Axiom Posterior Lateral Back

LS4x5L E0956, E1028 $650 $325


Axiom Back Accessories continued

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


q Small Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60153T E0960 $144

q Medium Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60154T E0960 $144

q Large Static Therafit 2-Piece Chest Strap with H & L Adj and 1” Safety Strap 60155T E0960 $144

q Small Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60110T E0960 $113

q Medium Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60111T E0960 $113

q Large Dynamic Therafit Chest Strap with Dual D-Ring Adjustment 60112T E0960 $113

q Small Dynamic Therafit Comfortfit Full Vest 30589T E0960 $167

q Medum Dynamic Therafit Comfortfit Full Vest 30590T E0960 $167

q Large Dynamic Therafit Comfortfit Full Vest 30591T E0960 $167

q XLarge Dynamic Therafit Comfortfit Full Vest 30592T E0960 $167

q XXLarge Dynamic Therafit Comfortfit Full Vest 30593T E0960 $167

q Small Dynamic Therafit Comfortfit Trim Vest 30618T E0960 $169

q Medum Dynamic Therafit Comfortfit Trim Vest 30619T E0960 $169

q Large Dynamic Therafit Comfortfit Trim Vest 30620T E0960 $169

q XLarge Dynamic Therafit Comfortfit Trim Vest 30621T E0960 $169

q XXLarge Dynamic Therafit Comfortfit Trim Vest 30622T E0960 $169

Therafin Posture Support

Choose modification to add holes to the back shell in order to mount posture supports. Not available with Low Backs.


q Modification for 4 Point Harness AXM4PT K0108 N/C

q Modification for 2 Point Chest Strap AXM2PT K0108 N/C

q Modification for Shoulder 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


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

qqqqqqqqq q - Ki Mobility · 2020-02-11 · Chair will ship from Ki Mobility with adaption kit...

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Transcript of qqqqqqqqq q - Ki Mobility · 2020-02-11 · Chair will ship from Ki Mobility with adaption kit...