order form

SEDEO® ERGO™ EIPW25

Customer Ship To

Account # Name

Date Address

PO# City

Buyer State Zip

Mark For Phone

ORDER FORMPrint pages 1-18 to exclude pictures.

Client Measurements

a) Top of head to seat in

b) Top of shoulder to seat in

c) Underarm to seat in

d) Elbow to seat in

e) Top of leg to seat in

f) Shoulder width in

g) Chest width in

i) Hip width in

j) Actual sitting depth in

m) Foot length in

n) Knee to foot in

o) Seat width in

Seating Specifications

HCPC K0861 / K0862 / K0884

Weights Starting at: (with Batteries) 374 lbs

Power Seating50° of CG Tilt and Power Recline with 7" mechanical sheer reduction / 12" seat elevation

Seat Type SEDEO ERGO

Seat Size Range Width 16" to 22" Depth 15" to 20"

Seat-to-Floor Height Range 17" to 19"

Mid-Wheel Drive Base Specifications

Drive Wheel Position Mid-wheel drive

User Weight Capacity 300 lbs. / 350 lbs. HD

Base Size Width 25", Length 36.5"

Turning Radius 19.8" (Excludes Footplates)

Drive Control R-net PM 120A, R-net PM 90A

Driving Range Up to 18 miles (w/ Group 24 Batteries)

Drive Motors 4-pole 6 mph, 5 mph, 8 mph

Drive Wheels 14" w/flat-free inserts (black) 14" w/pneumatic inserts (black)

Casters 6" front / 6" rear (black)

Charger 10A Dual Mode (Compact)

Battery Size Group 24 / Group 34

Color 8 shroud colors and 6 color accents

Ground Clearance 3"

Notes

Q700 M with SEDEO ERGO

2

Q700™ M Base End Item #EIPW25 $

250PC138 K0861

QUICKIE Q700 M MPC Tilt/Recline for SEDEO ERGOIncludes: R-net 90amp electronics, SpiderTrac® 2.0 6-wheel independent suspension, 14" drive wheels w/ dual density inserts, 6" flat free casters, ISO Occupied Tie-Down brackets, 10amp charger, 6 mph max speed, 300 lbs. weight cap., 17" STFH, 3" ground clearance

$8,007.00

250PC139 K0862

QUICKIE Q700 M MPC HD Tilt/Recline for SEDEO ERGOIncludes: R-net 90amp electronics, SpiderTrac® 2.0 6-wheel independent suspension, 14" drive wheels w/ dual density inserts, 6" flat free casters, ISO Occupied Tie-Down brackets, 10amp charger, 5 mph max speed, 350 lbs. weight cap., 17" STFH, 3" ground clearance

$10,302.00

250PC140 K0884

QUICKIE Q700 M MPD Tilt/Recline for SEDEO ERGOIncludes: R-net 120amp electronics, SpiderTrac® 2.0 6-wheel independent suspension, 14" drive wheels w/ dual density inserts, 6" flat free casters, ISO Occupied Tie-Down brackets, 10amp charger, 8 mph max speed, 300 lbs. weight cap., 17" STFH, 3" ground clearance

$12,750.00

User Weight $

250WG22 – Up to 250 lbs. NC

250WG03 – 251 to 300 lbs. NC

250WG15 – 301 to 350 lbs. NC

Motor Package $

250PF98 – 4-pole 8 kph / 5 mph (Standard for Group 3 HD K0862) NC

250PF99 – 4-pole 10 kph / 6 mph (Standard for Group 3 K0861) NC

250PF100 – 4-pole 12.5 kph / 8 mph (Standard for Group 4 K0884) NC

250PF101 – 4-pole 12.5 kph / 8 mph (Upgrade for Group 3 K0861) $1,173.00

Tracking $

250MI01 K0108 SureTrac® Module & Motor Encoders (Improves drive tracking.) $1,423.00

Drive Wheels P. 19 $

250DW58 – Drive Wheel, 14", Dual Density, Knobby, Black NC

250DW68 – Drive Wheel, 14", Pneumatic, V-type, Black $255.00

Caster Wheels P. 19 $

250CW55 – Caster Wheels 6", Solid, Black NC

Wheel Locks $

250WL42 – Wheel Locks $107.00

BASEOPTION HCPC DESCRIPTION RETAIL


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Shroud Color $

250C119 – Matte Black NC

250C165 – Candy Apple Red NC

250C166 – Candy Blue NC

250C167 – Candy Purple NC

250C176 – Green Apple NC

250C178 – Pearl Pink NC

250C182 – Silver NC

250C170 – American Flag $525.00

Color Accents $

250EZ20 – Apple Green NC

250EZ22 – Black NC

250EZ21 – Blue NC

250EZ23 – Orange NC

250EZ24 – Red NC

250EZ19 – White NC

Service Decals $

250D10 – Army NC

250D11 – Air Force NC

250D13 – Marines NC

250D14 – Navy NC

250D15 – Purple Heart NC

ISO Transit Tie Downs $

250TO50 – ISO Transit Package NC

LED Lights P. 19 $

250LI04 – LED Lights and Indicators $1,224.00

250LI02 – Omit LED Lights NC


Color Accents

Choose Color

Black

Black

Black

Black

Black

Black

Black


4

Seat Heights $

Note: Available seat-to-floor heights are dependent on 3 options: 1- Battery size (Pg 4), 2- Seat Frame "A" or "B" (Pg 5) and 3- Seat elevator (Pg 5). Use the matrix below to determine available ranges for your desired options. Measured from front of seat pan to floor.

250HT55 – NC

250HT104 – NC

250HT56 – NC

250HT105 – NC

250HT57 – NC

Batteries and Chargers P. 19 $

Group 24 Battery Options (Recommended for max daily range)

250AG25 E2363 GP24 Flat Top Pair w/Strap MK Gel $995.00

250AG26 E2363 GP24 Flat Top Pair w/Strap Brightway AGM $750.00

Group 34 Battery Options (Required for lower seat-to-floor heights)

250AG27 E2359 GP34 Flat Top Pair w/Straps MK Gel $959.00

250AG29 E2359 GP34 Flat Top Pair w/Straps Brightway AGM $724.00

Omit Batteries

250AG24 – Battery Harnesses Only (Omit Batteries) NC

Chargers

250BJ28 – 10A Dual Mode (Compact) NC


Battery Options

Seat Height Seat Frame "A" Seat Frame "B" UP

Without Elevate With Elevate Without Elevate With Elevate

17" GP34 GP34 NA NA NA

17.5" GP34 GP34 NA NA NA

18" GP24 or GP34 GP34 NA GP34 GP24

18.5" GP24 or GP34 GP24 or GP34 GP34 GP34 GP24

19" GP24 or GP34 GP24 or GP34 GP24 or GP34 GP34 GP24


5

Power Seating Options P. 19 $Seat Elevator (Optional)

250PI05 E2300C-Me® Seat Elevator, Powered, 300mm / 12" (Not available with HD or 8 mph motors.) For users less than 250 lbs. C-Me® speed can reach 3 mph. For users 251 to 300 lbs. C-Me speed can reach 2.4 mph.

$3,315.00

Seat Tilt/Recline (Must Choose One)

250PA31 E1007 Posterior 50° Tilt and Powered Recline, w/ 7" Shear Reduction $12,133.00

250PA33 E1007 Posterior 50° HD Tilt and HD Powered Recline, w/ 7" Shear Reduction $13,153.00

Power Recline Backrest Preset Home Angle $

250QK1 – 90° NC

250QK2 – 95° (Default position) NC

250QK3 – 100° NC

Back Frame Type $

250BF06 – Seat Frame "A" for lower STFH (Raised recline pivot point moves backrest / armrest 2" higher) NC

250BF07 – Seat Frame "B" (Lower recline pivot point for standard armrest and backrest height) NC

Back Cushion Type $

250BT129 – SEDEO ERGO (Choose Seating in section A, page 6) NC

250BT130 – JAY® J3® (Choose Seating in section B, pages 7-8) NC

250BT131 – JAY® J3® Interface Only (Allows for JAY Your Way) NC

250BT132 – SEDEO Aftermarket Adapter (Height adjustable round tubes for traditional mounting) $459.00

250BT133 – OMIT (Shear back plate will have 4 mounting posts for personalized mounting. No headrest mount.) NC

POWERED SEATINGOPTION HCPC DESCRIPTION RETAIL


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A- SEDEO ERGO Back Cushion $

SEDEO ERGO Back Coding: (XX=Height, YY= Width, ZZ= Upholstery)

250NL01 E2620 Back Cushion, Shallow Contour 75mm / 3" Contour $765.00

250NL02 E2621 Back Cushion, Shallow Contour 75mm / 3" Contour for 22" wide $867.00

250NL03 E2620 Back Cushion, Deep Contour 150mm / 6" Contour (Aluminum support stucture) $765.00

250NL04 E2621 Back Cushion, Deep Contour 150mm / 6" Contour for 22" wide (Aluminum support stucture) $867.00

A- SEDEO ERGO Backrest Dimensions $

Back Width (YY) (Outside Dimension is approx 2" wider toward the bottom of cushion as it flares out)For Deep Contour backrest, structure will measure 1" narrower than stated width but cushion will measure selected width.

250BN22 – 400mm / 16" NC

250BN23 – 460mm / 18" NC

250BN24 – 500mm / 20" NC

250BN25 – 560mm / 22" NC

Back Height (XX) (Measured from Pan to Top of Back Cushion)

250B120 – 560mm / 22" (Not available with Seat Frame "A") NC

250B121 – 610mm / 24" NC

250B122 – 660mm / 26" NC

250B123 – 710mm / 28" (Not available with Seat Frame "B") NC

A- SEDEO Back Cushion Upholstery (ZZ) $

250BU31 – Cover - AIR FLOW 3DX (sf) NC

250BU32 – Cover - Lycra Stretch Outer Layer (xs) NC

250BU33 – Cover - Premium Leatherette w/ Perforated Inserts (pl) NC

A- SEDEO Back Cushion Lateral Thoracic Swing-Away Support Pads $

Lateral Thoracic Support Pads

250KD27 E0956 Lateral, Swing-Away, Adjustable, Long Pad 150 x 130mm / 6" x 5", Right $133.00

250KD28 E0956 Lateral, Swing-Away, Adjustable, Long Pad 150 x 130mm / 6" x 5", Left $133.00

250KD29 E0956 Lateral, Swing-Away, Adjustable, Short Pad 90 x 120mm / 3.5" x 4.5", Right $133.00

250KD30 E0956 Lateral, Swing-Away, Adjustable, Short Pad 90 x 120mm / 3.5" x 4.5", Left $133.00

Lateral Thoracic Swing-Away Hardware

250KE43 E1028 Lateral Swing-Away Hardware, Right $235.00

250KE44 E1028 Lateral Swing-Away Hardware, Left $235.00



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B- JAY J3 Back for Power Recline $

B- JAY J3 Back – Contour P. 20

250JP01 E2613 J3 PA Back for 14"-20" Wide (J3PAXXXYYZZ) $546.00

250JP02 E2614 J3 PA Back for 22" Wide (J3PAXXXYYZZ) $811.00

250JP11 E2615 J3 PL Back for 14"-20" Wide (J3PLXXXYYZZ) $638.00

250JP12 E2620 J3 PDC Back for 14"-20" Wide (J3PDCXXXYYZZ) $765.00

250JP13 E2620 J3 PD Back for 14"-20" Wide (J3PDXXXYYZZ) $765.00

B- JAY J3 Back – Width Back can be ordered a different width than seat pan. $

250JQ01 – 14" NC

250JQ02 – 16" NC

250JQ03 – 18" NC

250JQ04 – 20" NC

250JQ05 – 22" NC

B- JAY J3 Shell Options and Height Ranges $JAY J3 shells are mounted with a minimim 4" gap between the bottom of the shell to the seat pan to accommodate the mechanical shear. Back height can be adjusted in the field within the ranges shown based on the back frame type (A or B) and the amount of usable hardware adjustability.

Frame A Frame BJAY J3 Shell Height min max min max

250JR13 – 15" Tall Shell (Mid Thoracic Tall) – 24" – 22" NC

250JR14 – 16.5" Tall Shell (Upper Thoracic Short) 24" 25" 22" 23" NC

250JR15 – 18" Tall Shell (Upper Thoracic Med) 24" 26" 22" 24" NC

250JR16 – 19.5" Tall Shell (Upper Thoracic Tall) 25" 27" 23" 25" NC

250JR17 – 21" Tall Shell (Shoulder Height) 26" 28" 25" 26" NC

250JR18 – 18" Tall Shell (Shoulder Height) for 22" Wide 26" 28" 24" 26" NC

JAY J3 Installed Back Height (From Pan to Top of Back)

250JR19 – 22" Minimum Height for "B" Frame NC

250JR20 – 23" NC

250JR21 – 24" Minimum Height for "A" Frame NC

250JR22 – 25" NC

250JR23 – 26" NC

250JR24 – 27" NC

250JR25 – 28" NC

B- JAY J3 Back Spine-Align Fit Kit 2 P. 20

250JS02 K0108 410mm / 16" $142.00

250JS03 K0108 460mm / 18" $142.00

250JS04 K0108 510mm / 20" $142.00

B- JAY Anterior Thoracic Support P. 20 Classic-Structure Pull Down Harness (4 point strap, only avail. w/JAY backrest) $250K10 E0960 Medium (ATS8302) $155.00

250K11 E0960 Large (ATS8303) $155.00

250K12 E0960 Extra Large (ATS8304) $155.00



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B - JAY® J3 Lateral Thoracic Swing-Away Supports $

Lateral Thoracic Support Pads

250JW05 E0956 Lateral Thoracic (LxH) 100mm x 100mm / 4" x 4" Pad - Right $128.00

250JW11 E0956 Lateral Thoracic (LxH) 100mm x 100mm / 4" x 4" Pad - Left $128.00

250JW06 E0956 Lateral Thoracic (LxH) 100mm x 127mm / 4"x 5" Pad - Right $128.00

250JW12 E0956 Lateral Thoracic (LxH) 100mm x 127mm / 4"x 5" Pad - Left $128.00









Lateral Thoracic Swing-Away Hardware

250JW17 E1028 Lateral Thoracic Swing-Away Bracket - Right $268.00

250JW18 E1028 Lateral Thoracic Swing-Away Bracket - Left $268.00

Headrest – Pad P. 22 $NOTE: If Specialty Input Devices are selected that require a headrest, please select your headrest post in the Specialty Input Devices section.

250HE36 E0955 SEDEO Pad Small With Cover (LxH) 240 x 150mm / 9.5" x 6" Can only be used with Multi-Position Headrest Mount with Quick-Release $164.00

250HE37 E0955 SEDEO Pad Flexible, (LxH) 400 x 110mm / 16" x 4.5" Can only be used with Multi-Position Headrest Mount with Quick-Release $265.00

250HE38 E0955 Whitmyer® Plush Headrest Pad 203mm / 8" $209.00

250HE39 E0955 Whitmyer Plush Headrest Pad 254mm / 10" $209.00

250HE44 E0955 Whitmyer Plush Headrest Pad 356mm / 14" $219.00

250HE45 E0955 Whitmyer Adjust-A-Plush Headrest Pad Small (Narrow) (Adjustable from 6"-14" wide x 3" Tall) $321.00

250HE46 E0955 Whitmyer Adjust-A-Plush Headrest Pad Medium (Adjustable from 7"-16" wide x 4" Tall) $321.00

250HE47 E0955 Whitmyer Adjust-A-Plush Headrest Pad Large (Standard) (Adjustable from 8"-18" wide x 5" Tall) $321.00

Headrest – Mount P. 22 $

250MH26 E1028 SEDEO Multi-Position Headrest Mount with Quick Release (Only available with SEDEO Pad) $204.00

250MH27 E1028 Whitmyer Linx Headrest Mount w/ Quick Release $168.00

250MH28 E1028 Whitmyer Linx2 Headrest Mount w/ Quick Release $204.00

250MH29 E1028 Whitmyer Axys Headrest Mount w/ Quick Release $107.00

250MH30 E1028 Whitmyer Axys Offset Headrest Mount w/ Quick Release $128.00

250MH31 E1028 Whitmyer Cobra FB Headrest Mount w/ Quick Release $306.00

Push Handles $

250PH23 – Fixed Cane Handles (Not available with O2 holder) NC

250PH24 – Height Adjustable with 2 Utility Hooks $56.00



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Seat Cushion Type $

250ST73 – SEDEO (See Section C) NC

250ST74 – JAY (See Section D) NC

250ST75 – Omit NC

C - SEDEO ERGO Seat Size and D - JAY Seat Size $

Seat Pan Width (Seat cushion width is dependent upon bolster selection. See thigh bolster section for limitations.)

250R53 – 16" NC

250R54 – 17" NC

250R55 – 18" NC

250R56 – 19" NC

250R57 – 20" NC

250R58 – 21" NC

250R59 – 22" NC

Seat Pan Depth (Front of Seat Pan to Front of Back Cushion Effective Depth)

250RF53 – 15" NC

250RF51 – 16" NC

250RF45 – 17" NC

250RF46 – 18" NC

250RF47 – 19" NC

250RF48 – 20" NC

C - SEDEO Cushions P. 20 $

250CU52 E2607 JAY ION® Cushion w/ 3DX Cover $403.00

250CU53 E2607 JAY ION Cushion w/ 3DX and Black Stretch $403.00

250CU54 E2607 JAY ION Cushion w/ Premium Leatherette Cover $403.00



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D- JAY Seat Cushion P. 21 $

250CU55 E2622 JAY X2® Cushion (Sizes 16" to 20" Wide) $434.00

250CU56 E2622 JAY J2® Cushion (Sizes 16" to 20" Wide) $444.00

250CU57 E2623 JAY J2 Deep Contour Cushion (Sizes 16" to 20" Wide) $459.00

250CU58 E2623 JAY J2 Deep Contour Cushion (Size 22" Wide) $566.00

250CU59 E2607 JAY Ion® (Sizes 16" to 21" Wide) $403.00

250CU60 E2608 JAY Ion (Size 22" Wide) $505.00

250CU61 E2607 JAY Union® (Sizes 16" to 21" Wide) $454.00

250CU62 E2608 JAY Union (Size 22" Wide) $556.00

250CU63 E2607 JAY Union Reduced Profile (Sizes 16" to 20" Wide) $454.00

250CU64 E2622 JAY Fusion® (Sizes 16" to 21" Wide) $449.00

250CU65 E2623 JAY Fusion (Size 22" Wide) $536.00

250CU66 E2622 JAY Fusion Air Insert Single Valve (Sizes 16" to 21" Wide) $505.00

250CU67 E2623 JAY Fusion Air Insert Single Valve (Size 22" Wide) $592.00

250CU68 E2622 JAY Fusion Air Insert Dual Valve (Sizes 16" to 21" Wide) $510.00

250CU69 E2623 JAY Fusion Air Insert Dual Valve (Size 22" Wide) $597.00

250CU70 E2622 JAY Fusion Reduced Profile (Sizes 16" to 21" Wide) $449.00

250CU71 E2623 JAY Fusion Reduced Profile (Size 22" Wide) $536.00

250CU72 E2622 JAY Fusion Reduced Profile Air Insert Single Valve (Sizes 16" to 21" Wide) $505.00

250CU73 E2623 JAY Fusion Reduced Profile Air Insert Single Valve (Size 22" Wide) $592.00

250CU74 E2622 JAY Fusion Reduced Profile Air Insert Dual Valve (Sizes 16" to 21" Wide) $510.00

250CU75 E2623 JAY Fusion Reduced Profile Air Insert Dual Valve (Size 22" Wide) $597.00

250CU76 E2624 JAY Fusion Positioning (Sizes 16" to 21" Wide) $469.00

250CU77 E2625 JAY Fusion Positioning (Size 22" Wide) $556.00

250CU78 E2624 JAY Fusion Positioning Air Insert Single Valve (Sizes 16" to 21" Wide) $525.00

250CU79 E2625 JAY Fusion Positioning Air Insert Single Valve (Size 22" Wide) $612.00

250CU80 E2624 JAY Fusion Positioning Air Insert Dual Valve (Sizes 16" to 21" Wide) $530.00

250CU81 E2625 JAY Fusion Positioning Air Insert Dual Valve (Size 22" Wide) $617.00

D - JAY Bundling To order any JAY cushion not listed above, please see the JAY Price List. $Note: When ordering standard bolster side cushions, order JAY bundled cushion 2" narrower than effective seat width.

250JC20 – JAY Bundled Cushion See Price ListCushion name or part number Width Depth



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ERGO Thigh Bolster Note: bolster pads and mounts need to be ordered together as a pair, in thin or standard $Thigh Bolster Support Pads

250CR05 E0953 Bolster Side Cushion Standard 50mm / 2", Right (Cushion width 2" narrower than seat width) $133.00

250CR06 E0953 Bolster Side Cushion Standard 50mm / 2", Left (Cushion width 2" narrower than seat width) $133.00

250CR07 E0953 Bolster Side Cushion Thin 25mm / 1", Right (Cushion width equals seat width ordered) $133.00

250CR08 E0953 Bolster Side Cushion Thin 25mm / 1", Left (Cushion width equals seat width ordered) $133.00

Thigh Bolster Mounting

250CR09 E1028 Bolster Swing-Away / Removable Bracket Right (Not available with 2-point armrest) $235.00

250CR10 E1028 Bolster Swing-Away / Removable Bracket Left (Not available with 2-point armrest) $235.00

250CR11 – Bolster Fixed Bracket Right NC

250CR12 – Bolster Fixed Bracket Left NC

Traditional Knee and Thigh Swing-Away Support Pads $Lateral Knee Support Pads and Hardware (Must pick pad and mount)

250XY05 E0953 Lateral Knee Support Pad, Right (4" round) $179.00

250XY06 E0953 Lateral Knee Support Pad, Left (4" round) $179.00

250XX08 E1028 Lateral Swing-Away Bracket Knee - Right $235.00

250XX09 E1028 Lateral Swing-Away Bracket Knee - Left $235.00

Lateral Thigh Support Pads and Hardware (Must pick pad and mount) (N/A with bolsters)

250KF08 E0953 Lateral Thigh Support Pad, Right (5"x10") $107.00

250KF09 E0953 Lateral Thigh Support Pad, Left (5"x10") $107.00

250KF10 E1028 Lateral Removable Bracket Thigh - Right $235.00

250KF11 E1028 Lateral Removable Bracket Thigh - Left $235.00

Armrest Structure P. 21 $

250EG30 – Armrest, Reclining, Flip Back (Arm height range 10" to 14" w/seat frame "B", 12" to 16" w/seat frame "A".) NC

250EG31 – Armrest, Reclining, Flip Back with 2-point post locking arm (Not available when backrest to seat width difference is greater than 2") (Arm height range 10" to 14" w/seat frame "B", 12" to 16" w/seat frame "A".) $255.00

Arm Pads P. 21 $Standard Waterfall Reclining Arm Pad (Upholstered in AIR FLOW - 3DX unless back is ordered in Leatherette)

250AB36 – Reclining Arm Pad, Standard, 410mm / 16" Right NC

250AE36 – Reclining Arm Pad, Standard, 410mm / 16" Left NC

Comfort Reclining Arm Pad (Foam)

250AB37 – Comfort, Vinyl Cover, 50mm x 400mm, 2" x 16" Foam, Right $77.00

250AE37 – Comfort, Vinyl Cover, 50mm x 400mm, 2" x 16" Foam, Left $77.00

250AB38 – Comfort, Vinyl Cover, 100mm x 400mm, Left 4" x 16" Foam, Right $77.00

250AE38 – Comfort, Vinyl Cover, 100mm x 400mm, Left 4" x 16" Foam, Left $77.00

Comfort Reclining Arm Pad (Gel)

250AB39 – Comfort, Vinyl Cover, 50mm x 400mm, 2" x 16" Gel, Right $153.00

250AE39 – Comfort, Vinyl Cover, 50mm x 400mm, 2" x 16" Gel, Left $153.00

250AB40 – Comfort, Vinyl Cover, 100mm x 400mm, 4" x 16" Gel, Right $153.00

250AE40 – Comfort, Vinyl Cover, 100mm x 400mm, 4" x 16" Gel, Left $153.00

AES Trough/Elbow Block Reclining Arm Pad (Gel)

250AB41 E2209 3.5" x 13" Right $255.00

250AE41 E2209 3.5" x 13" Left $255.00

250AB42 E2209 4" x 14.5" Right $255.00

250AE42 E2209 4" x 14.5" Left $255.00

POSITIONING SUPPORTS & ACCESSORIESOPTION HCPC DESCRIPTION RETAIL


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Centermount Legrest P. 21 $

250H112 – SEDEO Fixed Centermount Legrest (3" to 17.5" Leg Length) NC

250H109 E1012 Power Centermount Legrest, 90° to 0° Angle, 7.5" Extension (Required if selecting memory seating, biometric repositioning, and PRAR) (3" to 17.5" Leg Length) $3,315.00

Footplates

250F127 K0040 Dual, Height and Angle Adjustable, Standard (13.5" to 14.5" wide X 10" long) $173.00

250F128 K0040 Dual, Height and Angle Adjustable, Large (15.5" to 16.5" wide X 12" long) $173.00

Calf Pad Options

250DI34 – Calf Pads, Pair, Standard NC

250DI35 – Extra Large Pair Calf Pads for Centermount Legrests. Fully adjustable. (Not available with standard footplate) $357.00

Pelvic Positioning Belts P. 22 $250A835 – Positioning Belt, Aircraft Buckle 50mm x 1300mm / 2" x 50" NC

250A836 E0978 Positioning Belt, Aircraft Buckle, Padded 50mm x 1300mm / 2" x 50" $77

Accessories $Ventilator Option

250VT11 E1029 Vent Tray Fixed (Pulmonetic LTV Models) $474.00

O2 Tank Option

250A703 E2208 O2 Tank Holder to Backrest Styles (Not available with fixed push handles) $332.00

Wheelchair Tray Table

2507A08 E0950 Tray, Swing-Away $357.00

Backpack

250A1 – Black Utility $56.00

Misc. Accessories

2508A52 – Ram Mount Phone $87.00

2508A53 – Ram Mount Tablet $357.00

2508A54 – Ram Mount Cup Holder $87.00

2508A55 – Rear View Mirror $87.00

POSITIONING SUPPORTS & ACCESSORIESOPTION HCPC DESCRIPTION RETAIL


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R-net Joystick (Remote) P. 22 $250J116 – Color Joystick (2.3" Color LCD Screen Display, CJM1) NC

250J117 – Heavy Duty Color Joystick (2.3" Color LCD Screen Display, Fixed Joystick Mount only) $1,173.00

250J118 –High Resolution Color Joystick, (CJSM2+BT) 3.5" Color LCD Display, Paddle Switches, Programmable Shortcut Keys, ICONs, Stereo Jack, IR and Dual (iOS/Android) Bluetooth Control

$1,076.00

250J119 – Omit Remote Control (Required with arm mounted specialty controls and table top control) –$25.00

Joystick Mounting $250JM31 – Fixed on Armrest NC

250JM32 E1028 Parallel Swing-Away $301.00

250JM33 E1028 Link-It Mid-Line Mount on Armrest (Swing-Away) $867.00

Joystick Mount (Location) $250HM16 – Right Hand Armrest NC

250HM17 – Left Hand Armrest NC

Display Language Selection R-net $250L1 – English NC

250L3 – French NC

250L7 – Spanish NC

Joystick Handle (Optional) P. 22 $250JH13 E2323 Ball Handle $128.00

250JH14 E2323 Foam Ball Handle $128.00

250JH15 E2323 T-Handle $128.00

250JH16 E2323 Goalpost $128.00

Electronic Programmers P. 23 $250PR10 – R-net PC Programmer w/ Dongle $536.00

R-net Power Modules P. 23 $250ER17 – Power Module, R-net, 90A, Expandable $1,270.00

250EX15 E2377 Expandable 90A Controller - R-net $668.00

250EX16 E2313 Harness for 90A Expandable Controller $602.00

250ER10 – Power Module, R-net, 120A, Expandable (Only available with Group 4) $1,270.00

250EX09 E2377 Expandable 120A Controller - R-net $668.00

250EX10 E2313 Harness for 120A Expandable Controller $602.00

R-net Seating Module Control $250EO32 E2311 Actuator Control Module, R-net, CxSM, Thru Drive 2+ Actuators $3,545.00

Attendant Controls P. 23 $2500A05 E2331 Dual Control Module for Attendant $1,326.00

2500A06 E2331 R-net Color LCD (CJSM1) Control Attendant Only $1,326.00

Attendant Mounting Location $250DN1 – Right Back Cane NC

250DN2 – Left Back Cane NC

JOYSTICK / ELECTRONICS See Last Pages For Specialty Input Devices images

OPTION HCPC DESCRIPTION RETAIL


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#1 Ctrl+5® Switchbox Options P. 23 $250QG09 – #1 Ctrl+5 Switch Box w/ Free Assignable Functions and Switch-It™ Remote Seating™ NC

#1 Ctrl+5 Mounting Location

250EY09 – Right Armrest NC

250EY10 – Left Armrest NC

250EY11 – Back Cane, Right $153.00

250EY12 – Back Cane, Left $153.00

#1 Ctrl+5 Switch Type $250EY03 – Push Buttons NC

250EY17 K0108 Toggle Switches $306.00

#2 Ctrl+5 Switch Option $250QG10 – #2 Ctrl+5 Switch Box with Free Assignable Functions $1,275.00

#2 Ctrl+5 Mounting Location

250EY13 – Right Armrest NC

250EY14 – Left Armrest NC

250EY15 – Back Cane, Right $153.00

250EY16 – Back Cane, Left $153.00

#2 Ctrl+5 Switch Type $250EY05 – Push Buttons NC

250EY18 K0108 Toggle Switches $306.00

R-net Programming Selection $Biometric Repositioning

250PM03 K0108 Include Biometric Repositioning (Requires Memory Position #1, #2, #3 Below) $153.00

250PM04 – Omit Biometric Repositioning NC

Memory SeatingMemory Seating feature allows for up to 6 personalized seating positions that are accessed either through the joystick, Ctrl+5, joystick shortcut keys or programmable jacks on Omni2 and joystick. Choose desired presets below. Default positions are dealer adjustable.

250PM05 – Omit Memory Seating NC

250PM06 – Include #1 Memory Seating (Seated: Required as return position from all other positions) NC

250PM07 K0108 Include #2 Memory Seating (Supine) $51.00

250PM08 K0108 Include #3 Memory Seating (Pressure Relief) $51.00

250PM09 K0108 Include #4 Memory Seating (Feet Above Heart) $51.00

250PM10 K0108 Include #5 Memory Seating (Transfer) (Requires Seat Elevator selection) $51.00

250PM11 K0108 Include #6 Memory Seating (C-Me) $51.00

Assignable Buttons

250PM12 – Include Assignable Buttons NC

PRAR Pressure Relief Alert and Recording

250PM14 K0108 Include PRAR (Minimum Requirement Memory Position #1 and #3) $153.00

Power Centermount Footplate Extension Option

250IE03 K0108 Include 7.5" Powered Footplate Extension for Transfer Assist (Electronics programmed to allow footplates to be extended with or without legrest being raised.) $1,275.00

JOYSTICK / ELECTRONICS See Last Pages For Specialty Input Devices images



15

R-net Omni2 Options P. 23 For Expandable Controls, choose all that apply. $

250ON14 – R-net Omni2 Only Input Control Module and 3.5" LCD Display w/ Built-In Infrared & Bluetooth, Choose Mount Below $1,811.00

250ON15 – R-net Omni2 Bundled Input Control Module and 3.5" LCD Display w/ Built-In Infrared & Bluetooth, Bundled Omni2 Available w/ Switch-It Input Devices NC

Omni2 Mount If used w/ Standard Joystick, it must be mounted opposite side. $250DS12 E1028 Link-It with Parallel Swing-Away Omni2 Mount w/ Rear Mounted Interface, Right $505.00250DS13 E1028 Link-It with Parallel Swing-Away Omni2 Mount w/ Rear Mounted Interface, Left $505.00

Hand Control Packages P. 24 Requires Standard Joystick Omit / Only one hand control device can be ordered. $Proportional Input Devices

250EU14 E2312 Switch-It MicroGuide $3,361.00250EU15 E2312 Switch-It MicroPilot $3,361.00250EU16 K0108 Switch-It TouchDrive 2 $3,922.00250EU17 E2328 Switch-It VersaGuide $1,851.00250EU18 E2328 Switch-It VersaGuide EZ $2,188.00

Mounting Position (Required)250EM04 – Link-It to the Backrest (Not Available w/ Omit Back Cushion Type) $969.00250EM05 – Link-It to the Fixed Joystick Mount $301.00250EM06 E1028 Link-It to the Parallel Swing-Away Joystick Mount $505.00250EM07 E1028 Link-It to the Midline Swing-Away $1,071.00250EM08 – Omit Mount NC

Mounting Platforms (Optional) Not available w/ Link-It to Backrest250MG16 E0950 SunDisk Hand Tray (Only available w/ MicroSeries Joysticks) $301.00250MG15 E0950 Bullet Hand Tray $301.00

Mounting Location (Required)250IM09 – Right NC250IM10 – Left NC

Switch Options– – See Switch Selections (Maximum 2) –

Head Control Packages P. 24 Only one head control device can be ordered. Must select headrest mount on next page. $Proportional Input Devices

250EU25 E2328 Switch-It DualPro® Proportional Head Array - Facial Pads $5,829.00250EU44 E2328 Switch-It DualPro Proportional Head Array - Facial Pads - Dedicated Mode Outer Left $6,115.00250EU45 E2328 Switch-It DualPro Proportional Head Array - Facial Pads - Dedicated Mode Outer Right $6,115.00250EU46 E2328 Switch-It DualPro Proportional Head Array - Facial Pads - Dedicated Mode & Reverse $6,319.00250EU26 E2328 Switch-It DualPro Proportional Head Array - Spot Pads $5,829.00250EU27 E2328 Switch-It RIM Proportional Head Control $6,013.00

Switched Input Devices250EU28 E2330 Switch-It 3-Switch Head Array - Short Curved Wings $4,483.00250EU29 E2330 Switch-It 3-Switch Head Array - Short Straight Wings $4,483.00250EU30 E2330 Switch-It 3-Switch Head Array - Long Curved Wings $4,483.00250EU31 E2330 Switch-It 3-Switch Head Array - Long Straight Wings $4,483.00250EU42 E2330 Switch-It 4-Switch Head Array - Long Straight Wings Only - Mode Outer Left $4,687.00250EU43 E2330 Switch-It 4-Switch Head Array - Long Straight Wings Only - Mode Outer Right $4,687.00250EU33 E2330 Switch-It 5-Switch Head Array - Long Straight Wings Only - Mode Outer Left $4,820.00250EU47 E2330 Switch-It 5-Switch Head Array - Long Straight Wings Only - Mode Outer Right $4,820.00

Switch Options– – See Switch Selections (Maximum 2) –

SPECIALTY INPUT DEVICES See last page for Specialty Input Device images.



16

Sip 'N Puff $

250ID73 E2330 Switch-It Sip 'N Puff Combo Head Array with Link-It Hardware (Requires headrest mount) $5,095.00

250ID74 K0108 Switch-It OptiStop with Sip 'N Puff $1,984.00

Headrest Mounts (Applies to Head/Sip 'N Puff control packages.) $

250IJ13 E1028 Whitmyer® Linx Headrest Mount w/ Quick Release $168.00

250IJ14 E1028 Whitmyer Linx2 Headrest Mount w/ Quick Release $204.00

250IJ15 E1028 Whitmyer Axys Headrest Mount w/ Quick Release $107.00

250IJ16 E1028 Whitmyer Axys Offset Headrest Mount w/ Quick Release $128.00

250IJ17 E1028 Whitmyer Cobra FB Headrest Mount w/ Quick Release $306.00

Chin Control Packages P. 24 $Proportional Input Devices

250EU34 E2312 Switch-It MicroGuide (Switches mounted to the headrest only.) $3,361.00

250EU35 E2312 Switch-It MicroPilot (Switches mounted to the headrest only.) $3,361.00

250EU36 E2328 Switch-It VersaGuide $1,851.00

250EU37 E2328 Switch-It VersaGuide EZ $2,188.00

Mounting Position

250EM09 E1028 Link-It to Chin Harness, Small (150mm / 6") $1,275.00

250EM10 E1028 Link-It to Chin Harness, Large (220mm / 8.5") $1,275.00

250EM11 E1028 Link-It to Headrest S/A $1,275.00

250EM12 E1028 Link-It to Manual Chin Boom - Right Side $3,871.00

250EM13 E1028 Link-It to Manual Chin Boom - Left Side $3,871.00

250EM16 E1028 Omit Mount NC

Input Device Mounting Location

250IM13 – Right NC

250IM14 – Left NC

Switch Options

– – See Switch Selections –

Safety Devices $250SA06 – Switch-It Remote Stop Switch - XLR Connector $954.00

Switched Driving Packages $

250SW44 E2328Switch-It® Cool Cube® with DB9 connector for proximity/proportional switch driving (Pro Spot® proportional switches are required if proportional driving is desired.) (For non-proportional driving, single switches can be used.)

$3,539.00




17

Switches P. 25

Single switches can be programmed to activate any function of the wheelchair including: On/Off, Mode, Profile, Speeds, Seating, Memory Positions, Horn, Lights & Indicators, IR functions, Bluetooth mouse clicks, Environmental Controls when plugged into assignable port. Switches can connect via: Joysticks (Standard, Micro series, Versa series) Omni2, Cool Cube®, head controlsSwitch ordering instructions:

1. Select switch type and quantity in Section "A" using colums below. (Max 6 switches. See limitations below.)2. Select switch mounting position from Section "B" using corresponding switch column. 3. Select switch mounting location from Section "C" using corresponding switch column.

Section A – Switch Selections Switch / QuantitySingle Function Switches - Mechanical Switches Switch 1 Switch 2 Switch 3 Switch 4 Switch 5 Switch 6 $2.5" Single Switch - Black $199.002.5" Single Switch - Blue $199.002.5" Single Switch - Green $199.002.5" Single Switch - Red $199.002.5" Single Switch - Yellow $199.00Egg Switch - Black $112.00Egg Switch - Blue $112.00Egg Switch - Green $112.00Egg Switch - Red $112.00Egg Switch - Yellow $112.00MicroLite (Includes color labels) $168.00Mini Button 1 - Blue (Velcro) $107.00Mini Button 1 - Green (Velcro) $107.00Mini Button 1 - Red (Velcro) $107.001" Single Switch - Black $281.001" Single Switch - Blue $281.001" Single Switch - Green $281.001" Single Switch - Orange $281.001" Single Switch - Red $281.001" Single Switch - Yellow $281.00Twister Switch - Black (Must choose mount and location) $179.00Twister Switch - Green (Must choose mount and location) $179.00Twister Switch - Red (Must choose mount and location) $179.00Electronic SwitchesFlex Switch (Headrest mount only) $219.00Zero Touch Proximity Sensor $199.00

Section B – Switch Mounting PositionLink-It to the Backrest (Up to 1 per side) $663.00Headrest Mount - Gooseneck & Rigid (Up to 2 per side) $663.00Link-It to the Fixed Joystick Mount (Up to 2 per side) $505.00Link-It to the Parallel Swing-Away Joystick Mount (Up to 2 per side) $505.00

Link-It to the Seat Rail (Up to 2 per side) (Not avail w/knee & thigh supports) $403.00

Omit Mount (includes Velcro) NCSection C – Switch Mounting Location

Right side of chair $250.00Left side of chair $250.00

Joystick Integrated Switches (Pair)250JO03 – Proximity Switches on Flex Mount, Pair (Used with VersaGuide/VersaGuide EZ) $1,015.00

Additional Switches (Velcro)250SA08 K0108 Mini 2 - Button (Stereo Plug) $245.00250SA09 K0108 Mini 2 - Button (Dual Mono Plug) $245.00250SA10 K0108 Mini 4 - Button In-Line (DB9 connector) $556.00




18

MAX TRUNK WIDTH

16”

BACK WIDTH

16”

SEDEO ERGOSHALLOW CONTOUR

SEDEO ERGODEEP CONTOUR SEDEO ERGO

THIN SIDE BOLSTERS

SEDEO ERGOSTANDARD SIDE BOLSTERS

CUSHION WIDTH16”

CUSHION WIDTH14”

SEAT WIDTH

16”

MAX TRUNK WIDTH

18”

POWER BASE

POWER SEATING

250BJ28

250DW58 250DW68

250PI05

250CW55

250LI04

Charger

14" Drive Wheel, Knobby

Power Seating: Tilt, Recline

14" Drive Wheel, V-type

Power Seating: Elevate

Caster Wheel

LED Lights

250PA31 – 250PA33


19

MAX TRUNK WIDTH

16”

BACK WIDTH

16”

SEDEO ERGOSHALLOW CONTOUR

SEDEO ERGODEEP CONTOUR SEDEO ERGO

THIN SIDE BOLSTERS

SEDEO ERGOSTANDARD SIDE BOLSTERS

CUSHION WIDTH16”

CUSHION WIDTH14”

SEAT WIDTH

16”

MAX TRUNK WIDTH

18”

SEATING AND POSITIONING

250JS02 – 250JS04

250JP01 & 250JP02

250K10 – 250K12

250ST73

250JP11 250JP13250JP12

JAY® J3® Back, Spine-Align Kit 2

JAY® J3® PA Back: 2.2"

JAY® Anterior Thoracic Support

SEDEO® ERGO™ Cushions

JAY® J3® PL Back: 3" JAY® J3® PD Back: 6"JAY® J3® PDC Back: 6"

2.2" 3" 6"6"


20


250CU59 – 250CU60

250CU55

250CU61 – 250CU62

250CU56

250CU66 – 250CU69

250CU57 – 250CU58

250CU64 – 250CU65

JAY® Ion® Cushion

JAY® X2® Cushion

JAY® Union® Cushion

JAY® J2® Cushion

JAY® Fusion® Cushion w/Air

JAY® J2® Deep Contour Cushion

JAY® Fusion® Cushion w/Fluid

250EG30

250AB38

250AB36 250AB37

Reclining, Flip-Back Armrest

Comfort Reclining Arm Pad, 4"

Standard Reclining Arm Pad Comfort Reclining Arm Pad, 2"

250EG31

Reclining, Flip-Back, 2-Point Armrest

250H109

Power Centermount Legrest


21


ELECTRONICS

250A835 – 250A836

250J116

250HE38 – 2050HE44

250JH16

250HE36

250HE45 – 250HE47

250JH15

250HE37

250J117 250J118

250MH27

250JH14

250MH26

250MH28

250JH13

Positioning Belt, Aircraft Style

Color Joystick (CJSM1)

Whitmyer® Plush Headrest

Goalpost Joystick Handle

SEDEO® Headrest Pad, Small

Whitmyer® Adjust-a-Plush Headrest

T-Handle Joystick Handle

SEDEO® Headrest Pad, Flexible

Heavy Duty Color Joystick High Resolution Color Joystick (CJSM2+BT)

Whitmyer® Linx Headrest Mount

Foam Ball Joystick Handle

SEDEO® Multiposition Headrest Mount

Whitmyer® Linx-2 Headrest Mount

Ball Joystick Handle


22

ELECTRONICS

250PR10 250ER10 2500A05

R-net PC Programmer R-net Power Module Attendant Control

250EY03

Ctrl+5 with Buttons

250EY17 250ON14

Ctrl+5 with Toggles R-net Omni2 Input Control Module


23

INPUT DEVICES AND MOUNTS

250EU28 – 250EU31 250EU27

250EU14, 250EU34

250EM04

250EM09

250EU25 – 250EU26

250EU15, 250EU35

250EM05

250EM11

250EU17, 250EU36

250EM06

250EM12

250EU16

250EM07

Switch-It® 3-Switch Head Array Switch-It® RIM Proportional Head Control

MicroGuide

Link-It to Backrest

Link-It to Chin Harness

Switch-It® DualPro® Proportional Head Array

MicroPilot

Link-It to Fixed Joystick Mount

Link-It to Headrest

VersaGuide

Link-It to Swing-Away Joystick Mount

Link-It to Manual Chin Boom

TouchDrive 2 (TD2)

Link-It to Midline Swing-Away


24

INPUT DEVICES AND MOUNTS

2.5" Single Switch black, blue, green, red, yellow

Twister Switch black, green, red

Egg Switch black, blue, green, red, yellow

Mini 2

MicroLite

Mini 4

1" Single Switch black, blue, green, orange, red, yellow

Mini 1 Button (Mono Plug) blue, green, red


25

Date Signature

Q700 M with SEDEO ERGO $

Base Price

Total of additional equipment

Packaging and transport

Total Price

DayMonth Year

Sunrise Medical (US) LLCFresno, CA 93727

3.2021 MK-129601 Rev. Iwww.SunriseMedical.com

800.333.4000

Comments for special build

order form

Documents