q option 1: setup by ki mobility frame width

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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: ________________________________________________ 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. q Focus CR - Transit Included E1161 _________________________ $3300 300 lb weight capacity. Includes one time free growth kit. Tilt range: -5º anterior to 50º posterior. q Focus CR - Transit Not Included E1161 ________________ $2980 300 lb weight capacity. Includes one time free growth kit. Tilt range: -5º anterior to 50º posterior. Frame Width Seating Setup Select Seat Depth corresponding to desired Frame Depth Range row and Backrest Offset column. Note: All Seat Depths in a column and within the same frame depth range are achievable with future adjustment. Frame Depth Range Backrest Offset q -2 q -1 q Flush q +1 q +2 q +3 q +4 Seat Depth q Short q 16 q 15 q 14 q 17 q 16 q 15 q 14 q 18 q 17 q 16 q 15 q 14 q 19 q 18 q 17 q 16 q 15 q 14 q 20 1 q 19 q 18 q 17 q 16 q 15 q 14 q Medium q 18 q 17 q 16 q 15 q 14 q 19 q 18 q 17 q 16 q 15 q 14 q 20 1 q 19 q 18 q 17 q 16 q 15 q 14 q 21 1 q 20 1 q 19 q 18 q 17 q 16 q 15 q 22 2 q 21 1 q 20 1 q 19 q 18 q 17 q 16 q Long q 20 1 q 19 q 18 q 17 q 16 q 15 q 14 q 21 1 q 20 1 q 19 q 18 q 17 q 16 q 15 q 22 2 q 21 1 q 20 1 q 19 q 18 q 17 q 16 q 22 2 q 21 1 q 20 1 q 19 q 18 q 17 q 22 2 q 21 1 q 20 1 q 19 q 18 1 Price is $605 E2203 2 Price is $1025 E2204 A Select Frame Depth within desired Frame Depth Range Frame Depth Range Frame Depth q Short 14” - 18” q 14 q 15 q 16 q 17 q 18 N/C N/C N/C N/C N/C q Medium 16” - 20” q 16 q 17 q 18 q 19 q 20 N/C N/C N/C N/C $605 E2203 q Long 18” - 22” q 18 q 19 q 20 q 21 q 22 N/C N/C $605 $605 $1025 E2203 E2203 E2204 Make one selection from either Option 1 at right or Option 2 below based on desired seating setup Back Canes Back Canes Front of Chair Front of Chair 4” Forward 4” Forward 2” Forward 2” Forward Flush Flush 2” Rearward 2” Rearward Select Frame Width within desired Frame Width Range Frame Width Range Frame Width q Small 14” - 18” q 14 q 15 q 16 q 17 q 18 N/C N/C N/C N/C N/C q Medium 16” - 20” q 16 q 17 q 18 q 19 q 20 N/C N/C N/C N/C $500 E2201 q Large 18” - 22” q 18 q 19 q 20 q 21 q 22 N/C N/C $500 $500 $500 E2201 E2201 E2201 q X-Large 1 20” - 24” q 20 q 21 q 22 q 23 q 24 $500 $500 $500 $725 $725 E2201 E2201 E2201 E2201 E2202 1 400 lb Weight Capacity is required Phone (800) 981-1540 | Fax (715) 254-0996 [email protected] | www.kimobility.com DCN0031.34 Pricing and specifications subject to change without notice Page 1 of 7 A Frame Width Range / Frame Width q OPTION 1: Setup By Ki Mobility q OPTION 2: Setup By Frame Depth This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Seat Pan q Growing Adjustable Aluminum Seat Pan E2231 _____________________ $200 q Omit Seat Pan _____________________________________________________________________________________ N/C Effective 07/29/2021 Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________

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Page 1: q OPTION 1: Setup By Ki Mobility Frame Width

Company: ________________________________________________

Account Number: __________________ Date: _________________

q Quote q PO Number: ___________________________________

RTS: _____________________________________________________

Marked For: _______________________________________________

Ship To: __________________________________________________

Address: _________________________________________________

City: ________________________________ State: _____________

Zip: ________________ Phone: _____________________________

Email/Fax: ________________________________________________

HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions. Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer’s coverage policy.

q Focus CR - Transit Included E1161 _________________________ $3300300 lb weight capacity. Includes one time free growth kit. Tilt range: -5º anterior to 50º posterior.

q Focus CR - Transit Not Included E1161 ________________ $2980300 lb weight capacity. Includes one time free growth kit. Tilt range: -5º anterior to 50º posterior.

Frame Width

Seating Setup

Select Seat Depth corresponding to desired Frame Depth Range row and Backrest Offset column.Note: All Seat Depths in a column and within the same frame depth range are achievable with future adjustment.

FrameDepthRange

Backrest Offset

q -2 q -1 q Flush q +1 q +2 q +3 q +4

Seat Depth

q Short

q 16 q 15 q 14

q 17 q 16 q 15 q 14

q 18 q 17 q 16 q 15 q 14

q 19 q 18 q 17 q 16 q 15 q 14

q 201 q 19 q 18 q 17 q 16 q 15 q 14

q Medium

q 18 q 17 q 16 q 15 q 14

q 19 q 18 q 17 q 16 q 15 q 14

q 201 q 19 q 18 q 17 q 16 q 15 q 14

q 211 q 201 q 19 q 18 q 17 q 16 q 15

q 222 q 211 q 201 q 19 q 18 q 17 q 16

q Long

q 201 q 19 q 18 q 17 q 16 q 15 q 14

q 211 q 201 q 19 q 18 q 17 q 16 q 15

q 222 q 211 q 201 q 19 q 18 q 17 q 16

q 222 q 211 q 201 q 19 q 18 q 17

q 222 q 211 q 201 q 19 q 18

1 Price is $605 E2203 2 Price is $1025 E2204

A

Select Frame Depth within desired Frame Depth Range

Frame DepthRange

Frame Depth

q Short14” - 18”

q 14 q 15 q 16 q 17 q 18

N/C N/C N/C N/C N/C

q Medium16” - 20”

q 16 q 17 q 18 q 19 q 20

N/C N/C N/C N/C $605E2203

q Long18” - 22”

q 18 q 19 q 20 q 21 q 22

N/C N/C $605 $605 $1025E2203 E2203 E2204

Make one selection from either Option 1 at right or Option 2 below based on desired seating setup

Back CanesBack Canes

Front of ChairFront of Chair

4” Forward4” Forward

2” Forward2” Forward

FlushFlush

2” Rearward2” Rearward

Select Frame Width within desired Frame Width Range

Frame WidthRange

Frame Width

q Small14” - 18”

q 14 q 15 q 16 q 17 q 18

N/C N/C N/C N/C N/C

q Medium16” - 20”

q 16 q 17 q 18 q 19 q 20

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

q Large18” - 22”

q 18 q 19 q 20 q 21 q 22

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

q X-Large1

20” - 24”

q 20 q 21 q 22 q 23 q 24

$500 $500 $500 $725 $725E2201 E2201 E2201 E2201 E2202

1 400 lb Weight Capacity is required

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

DCN0031.34 Pricing and specifications subject to change without notice Page 1 of 7

A

Frame Width Range / Frame Width

q OPTION 1: Setup By Ki Mobility

q OPTION 2: Setup By Frame Depth

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

Seat Pan

q Growing Adjustable Aluminum Seat Pan E2231 _____________________ $200q Omit Seat Pan _____________________________________________________________________________________ N/C

Effective 07/29/2021Select if chair quote has: q Additional Ki Products with Different Quote/Order Number Quote/Order Number: ____________________

Page 2: q OPTION 1: Setup By Ki Mobility Frame Width

Frame Options

Offset Hanger Option

q Offset Hanger ______________________________________________________________________________________ $30Tilt Stop included. No anterior tilt.

Tilt Mechanism

Hand

q Hand Tilt - Right _________________________________________________________________________________ N/Cq Hand Tilt - Left ____________________________________________________________________________________ N/Cq Hand Tilt - Dual __________________________________________________________________________________ N/C

Backrest

Vent and Battery TrayRequires minimum 16” Seat Height. Not available on 14” or 15” Frame Widths, Attendant Foot Lock, 12” wheels, One Arm Drive, 5” casters or Power Tilt.

q Vent Tray E1029 _________________________________________________________________________________ $250Not available with Self Propel Axle Plate or Foot Tilt. Requires Anti-Tip.

q Battery Box Holder E1029 _____________________________________________________________ $250Available only with Dual Hand Tilt

q Vent Tray and Battery Box Holder E1029 __________________________________ $500Requires Anti-Tip. Available only with Dual Hand Tilt. Not available with Self Propel Axle Plate.

Foot

q Foot Tilt - Right ___________________________________________________________________________________ N/Cq Foot Tilt - Left ______________________________________________________________________________________ N/C

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

[email protected] | www.kimobility.com

Weight Capacity

q 300 lb ______________________________________________________________________________________________________ Stdq 400 lb (Heavy Duty) _________________________________________________________________________ $425

Available only with Long Frame Depth Range and 8” x 2” or 6” x 2” Casters

Power TiltNot available with Vent Tray, Battery Box Holder or 400 lb Weight Capacity. Includes anterior and posterior tilt stops.

q Power Tilt - Right E1002 ______________________________________________________________ $2195q Power Tilt - Left E1002 _________________________________________________________________ $2195

Power Tilt OptionsPower Tilt selection required

q Toggle Switch ________________________________________________________________________________________ Stdq Pendant Control _________________________________________________________________________________ N/C

Sent as accessoryq Interface for Adaptive Switching _________________________________________________ $275

Sent as accessory

Transit

q Transit System __________________________________________________________________________________ $320q Omit Transit __________________________________________________________________________________________ N/C

Stroller Handle Back Post OptionAvailable only with Stroller Handle Back Post

q Removable Stroller Handle Extension _________________________________________ $85

Other Backrest Options

q Non Folding Back ______________________________________________________________________________ N/CStandard with Reclining Back and Seating Dynamics Rocker Back

q Seating Dynamics Rocker Back K0108 __________________________________ $1995Available only with Non Folding Back. Not available with Angle Adjustable Locking Extendable Flip Up Armrest or 400 lb Weight Capacity.

q Adjustable Height Rigidizer Bar _____________________________________________________ $75Not available with 23” or 24” frame widths

Back PostStroller Handle Back Post (Folding)

q Short 20” ___________________________________________________________________________________ N/Cq Tall 24” ________________________________________________________________________________________ N/C

Fixed Height with Adjustable Handle (Folding)Not available with Seating Dynamics Rocker Back

q Short 22” ___________________________________________________________________________________ N/Cq Tall 26” ________________________________________________________________________________________ N/C

Adjustable Height with Adjustable Handle (Folding)q Short 18”-25” ___________________________________________________________________________ $25

Not available with O2 Holder or Seating Dynamics Rocker Back

q 18” q 19” q 20” q 21” q 22” q 23” q 24” q 25”

q Tall 20”-27” _______________________________________________________________________________ $2520”-22” Heights not available with Seating Dynamics Rocker Back

q 20” q 21” q 22” q 23” q 24” q 25” q 26” q 27”

Reclining Back with Adjustable Handle (Non-Folding)Not available with O2 Holder or Seating Dynamics Rocker Back. If no Recline Angle and Gas Spring selections are made, 0° - 65° and Standard Spring will be used.

q Short 22” ______________________________________________________________________________ $1000q Tall 26” ___________________________________________________________________________________ $1000

Recline Angle: q 0º - 65º E1225

q 10º - 75º E1225

q 20º - 85º E1226

Gas Spring: q Standard Springq Heavy Duty Spring

DCN0031.34 Pricing and specifications subject to change without noticePage 2 of 7

Page 3: q OPTION 1: Setup By Ki Mobility Frame Width

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

[email protected] | www.kimobility.com

Footrest

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

Footrest Extension Seat to Footrest Length

Extension TubeHangers(60º, 70º, 80º)

q Short q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5

q Medium q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 q 15.5

q Long q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18

FrontMountHangers 1

Standard Selections Requires 3” Extension

q Short(70º, 80º, 90º)

q 5 q 5.5 q 6 q 6.5 q 8.5 q 9 q 9.5

q 7 q 7.5 q 8 q 10 q 10.5 q 11

q Medium(70º, 80º, 90º)

q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 10.5 q 11 q 11.5

q 8 q 8.5 q 9 q 9.5 q 10 q 12 q 12.5 q 13

q Long(70º, 80º)

q 5 q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 8.5 q 12.5 q 13 q 13.5

q 9 q 9.5 q 10 q 10.5 q 11 q 11.5 q 12 q 14 q 14.5 q 15

Contracture Footrest

q Short q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5

q Medium q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5

q Long q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5

Peds 2

PRO ELRq Low Pivot q 7 3 q 7.5 3 q 8 3 q 8.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5

q High Pivot q 7 3 q 7.5 3 q 8 3 q 8.5 q 9 q 9.5 q 10

PRO ELR Low Pivot Setting

q Short 10.5 - 15.5

q Long 13 - 19

PRO ELR High Pivot Setting

q Short 8.5 - 17

q Long 11.5 - 17.51 See Minimum Front Seat Height chart below2 Comes standard with 3” Extension3 Not available on chairs 15” wide or more

Minimum Front Seat Height with Front Mount Hangers

Hanger Length Short Medium Long

Hanger Bend 70º 80/90º 70º 80/90º 70º 80º

Minimum Front Seat Height with Standard Selection

13” 13” 13” 13.5” 14.5” 15.5”

Minimum Front Seat Height with 3” Extension

13.5” 14” 15.5” 16” 17” 18”

3” ExtensionAvailable only with Front Mount Hangers.

q 3” Extension ________________________________________________________________________________________ N/Cq 3” Extension (Provided as Parts) ___________________________________________________ N/C

DCN0031.34 Pricing and specifications subject to change without notice Page 3 of 7

Bilateral Mount Center Mount

Hanger 60º 70º 80º 90º Retail

Extension Tube Mount q q q1 N/C

Front Mount q q1 q2 N/C

Pro Elevating Leg Rests (PRO ELR) E0990 q $295

Pediatric Pro Elevating Leg Rests (Peds PRO ELR) E0990 q $295

Contracture Footrest Bilatreral Mount 3 K0108 q $350

Contracture Footrest Center Mount 3 K0108 q $350

Omit Hangers q -$201 7” and 8” Casters may interfere with less than 5º tilt2 Not available with 7” or 8” Casters3 Aluminum Angle Adjustable footplates included. See image to right.

Hanger / Front Frame Bend PRO ELR CoverAvailable only on PRO ELR

q Gel Pad Cover K0108 ____________________________________________________________________ $340

Page 4: q OPTION 1: Setup By Ki Mobility Frame Width

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

[email protected] | www.kimobility.com

DCN0031.34 Pricing and specifications subject to change without notice Page 4 of 7

Hanger ReleaseNo selection needed with Contracture Footrest. If no selection is made 4-Way - In line Hanger Release will be used.

q Classic ___________________________________________________________________________________________________ N/Cq 4-Way - In line ______________________________________________________________________________________ Std

See reference A below. Not available with PRO ELR or Peds PRO ELR.

q 4-Way - Out _________________________________________________________________________________________ N/CSee reference B below. Not available with PRO ELR or Peds PRO ELR.

A B

Residual Limb Support

Heel Loop

Calf Strap

q Velcro Adjustable K0038 ___________________________________________________________________ $40q Padded Velcro Adjustable K0038 __________________________________________________ $68q Bodypoint Padded AeroMesh K0038 _________________________________________ $115

Not available with One Piece Flip Up Angle Adjustable Footplate

q Heel Loops E0951 ______________________________________________________________________________ $35q Adjustable Heel Loops E0951 ________________________________________________________ $50q Omit Heel Loops ________________________________________________________________________________ N/C

Footrest continued

Residual Limb Support E1020

q Right and Left ______________________________________________________________________ $790 q Left _____________ $395 q Right ____________ $395 q Omit Left Hanger _ -$10 q Omit Right Hanger _ -$10

Cover ______________________________________________ q Smooth q Air Mesh q Smooth q Air Mesh

Pad Size ___________________________________________ q 5 x 8 q 9 x 14 q 5 x 8 q 9 x 14 q 7 x 10 q 11 x 10 q 7 x 10 q 11 x 10 q 9 x 10 q 11 x 14 q 9 x 10 q 11 x 14

FootplateNo selection needed with Contracture Footrest

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

q Composite Angle Adjustable K0040 ___________________________________________ $185Not available with Front Mount Hanger or 14” Seat Width without Offset Hanger

q Aluminum Angle Adjustable K0040 _____________________________________________ $190q Aluminum Locking Multi-Angle Adjustable K0108 __________________ $300

Available only with Front Mount Hanger

q One Piece Flip Up Angle Adjustable K0040 ______________________________ $190Not available with Front Mount Hanger or PRO ELR

Page 5: q OPTION 1: Setup By Ki Mobility Frame Width

Select Seat Height corresponding to desired Rear Wheel and Caster Size

Seat Height, Casters and Rear Wheels

Seat Height / Caster Size / Rear Wheel Size

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

[email protected] | www.kimobility.com

DCN0031.34 Pricing and specifications subject to change without notice Page 5 of 7

RearWheelSize

Caster Size

5” 6” 6” x 2” 7” 8” 8” x 2”

Seat Height

12” 3

withPneumaticorPneumatic withAirlessInsertTire

q 13.5

q 14

q 14.5 q 14.5 q 14.5 q 17

q 17.5 q 17.5 q 17.5 q 17.5 q 17.5 q 17.5

q 18 q 18 q 18 q 18 q 18 q 18

q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5

q 19 q 19 q 19 q 19 q 19 q 19

q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5

12” 3

withFullPolyTire

q 16.5 q 16.5 q 16.5

q 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

12”withDrum Brake

q 13

q 13.5

q 14 q 14 q 14

q 14.5 q 14.5 q 14.5

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 2 q 20 2 q 20 2 q 20 2

16” 4

withPneumatic, Pneumatic with AirlessInsert or Full PolyTire

q 13

q 13.5

q 14 q 14 q 14

q 14.5 q 14.5 q 14.5

q 15 q 15 q 15 q 15

q 15.5 q 15.5 q 15.5 q 15.5

q 16 q 16 q 16 q 16 q 16 q 16

q 16.5 1 q 16.5 q 16.5 1 q 16.5 1 q 16.5 1

q 19 q 19 q 19 q 19 2 q 19 q 19

q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5

q 20 q 20 q 20 q 20 q 20 q 20

q 20.5 q 20.5 q 20.5 q 20.5 q 20.5 q 20.5

16” 4

withLow PolyTire

q 13

q 13.5

q 14 q 14 q 14

q 14.5 q 14.5 q 14.5

q 15 q 15 q 15 q 15

q 18 q 18 q 18 q 18 q 18 q 18

q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5

q 19 q 19 q 19 q 19 q 19 q 19

q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5

q 20 q 20 q 20 q 20 q 20 q 20

q 20.5 q 20.5 q 20.5

RearWheelSize

Caster Size

5” 6” 6” x 2” 7” 8” 8” x 2”

Seat Height

16” 4

withDrum Brake

q 13.5

q 14 q 14 q 14

q 14.5 q 14.5 q 14.5

q 15 q 15 q 15 q 15

q 15.5 q 15.5 q 15.5 q 15.5

q 16 q 16 q 16 q 16

q 18.5 q 18.5 q 18.5 q 18.5 q 18.5

q 19 q 19 q 19 q 19 q 19 q 19

q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5

q 20 q 20 q 20 q 20 q 20 q 20

q 20.5 q 20.5 q 20.5 q 20.5 q 20.5 q 20.5

20”

q 15 q 15 q 15 q 15

q 15.5 q 15.5 q 15.5 q 15.5

q 16 q 16 q 16 q 16 q 16 q 16

q 16.5 q 16.5 q 16.5 q 16.5 q 16.5 q 16.5

q 17 q 17 q 17 q 17 q 17 q 17

q 17.5 q 17.5 q 17.5 q 17.5 q 17.5 q 17.5

q 18 q 18 q 18 q 18 q 18 q 18

q 18.5 2 q 18.5 2 q 18.5 2 q 18.5 2

22”

q 16 q 16 q 16 q 16 q 16

q 16.5 q 16.5 q 16.5 q 16.5 q 16.5 q 16.5

q 17 q 17 q 17 q 17 q 17 q 17

q 17.5 q 17.5 q 17.5 q 17.5 q 17.5 q 17.5

q 18 q 18 q 18 q 18 q 18 q 18

q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5

q 19 q 19 q 19 q 19 q 19 q 19

q 19.5 q 19.5 q 19.5 q 19.5 q 19.5

24”

q 16.5 5 q 16.51,5 q 16.51,5

q 17 5 q 17 5 q 17 5 q 17 5 q 17 5 q 17 5

q 17.5 6 q 17.5 6 q 17.5 6 q 17.5 q 17.5 q 17.5 6

q 18 q 18 q 18 q 18 q 18 q 18

q 18.5 q 18.5 q 18.5 q 18.5 q 18.5 q 18.5

q 19 q 19 q 19 q 19 q 19 q 19

q 19.5 q 19.5 q 19.5 q 19.5 q 19.5 q 19.5

q 20 q 20 q 20 q 20 q 20 q 20 2

1 Available only with Full Poly tire2 Not available with Full Poly tire3 Not available with Vent and Battery Tray combination4 Seat heights higher than 16.5” with 16” wheel size are not available with Vent and Battery Tray combination5 Not available with Drum Brake6 Not available with Drum Brake in combination with Pneumatic tires

Page 6: q OPTION 1: Setup By Ki Mobility Frame Width

Rear Tire Type

q Full Poly E2218 _____________________________________________________________________________________ N/Cq Low Poly E2218 ___________________________________________________________________________________ N/C

Available only with 16” wheel size

q Pneumatic E2211, E2212 ____________________________________________________________________ N/Cq Pneumatic with Airless Insert E2211, E2213 _________________________________ $85

Handrim OptionNot available on Plastic Coated or Projection Handrims

q 3M Micro Grip _____________________________________________________________________________________ $65

Axle

Wheel Locks

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

[email protected] | www.kimobility.com

Handrim

q Aluminum Anodized ___________________________________________________________________________ Stdq Plastic Coated ___________________________________________________________________________________ $115q Projection (8 Vertical Projections) ________________________________________________ $325

Available only with 24” wheels

q Omit Handrims ____________________________________________________________________________________ N/C

Not available on 20” wheel size or 22” Mag wheel. Not recommended with Mag wheel.

q Natural Fit LT Regular Grip ____________________________________________________________ $465q Natural Fit Standard Regular Grip _______________________________________________ $445q Natural Fit LT Super Grip _______________________________________________________________ $515q Natural Fit Standard Super Grip __________________________________________________ $495q Natural Fit LT Omit Grip _________________________________________________________________ $395q Natural Fit Standard Omit Grip ____________________________________________________ $345

Natural Fit Handrims

Handrims not available on 12” or 16” wheel sizes. No selection needed with One Arm DriveStandard Handrims

One Arm Drive

q One Arm Drive E0958 __________________________________________________________________ $1295Available only with 24” Spoke wheels. Spoke wheel style is exclusive to OAD. Not available with Vent Tray, Battery Box Holder, Self Propel Axle Plate or Angle Adjustable Locking Extendable Flip Up. Standard Handrim will be Aluminum Anodized. Axle is Quick Release.

Rear Wheel Size: q 24”

Drive Handrim Side: q Left q Right

Drive Handrim Type: q Aluminum _______________________________________ N/C q Poly Coated _________________________________ $200

No selection needed with One Arm Drive or Drum Brake

q Fixed ______________________________________________________________________________________________________ N/Cq Quick Release _____________________________________________________________________________________ N/C

Wheel Lock

q Push to Lock ________________________________________________________________________________________ Stdq Pull to Lock __________________________________________________________________________________________ N/C

Not available with 12” or 16” Full Poly tires

q Attendant Foot Lock _________________________________________________________________________ $75q Drum Brake E2228 _________________________________________________________________________ $560

Available only with 12” Mag, 16” Mag, or MAXX Performance Spoke wheels. Not available with 16” Low Poly tire, Reclining Backrest, One Arm Drive or Self Propel Axle Plate. 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

q Combination Attendant Foot Lock _____________________________________________ $145Available only with 12” or 16” wheel sizes. Includes Extension Handles. Push to Lock only.

Dual - Drum Brake _________________________________________________________________________________ $660Available only with 12” Mag, 16” Mag, or MAXX Performance Spoke wheels. Not available with 16” Low Poly tire, Reclining Backrest, One Arm Drive or Self Propel Axle Plate. Axle is Quick Release.

q Push to Lock q Pull to Lock

DCN0031.34 Pricing and specifications subject to change without notice Page 6 of 7

q Self Propel Axle Plate _______________________________________________________________________ $95Not available with Vent Tray or 12” or 16” wheel sizes

Self Propel Axle Plate

Casters and Rear Wheels

Rear Wheel SizePrice 12” 16” 20” 22” 24”

Rea

r W

heel

Ty

pe

Mag N/C q q q q q

MAXX Performance Spoke $200 q

Caster SizePrice 5” 6” 7” 8”

Cas

ter

Typ

e

1” Poly N/C q q q q1” Poly Aluminum $110 q1” Pneumatic $110 q q1.5” Poly $85 q q1.5” Soft Roll Aluminum $175 q q2” Poly $90 q2” Pneumatic w/ Foam Insert $225 q

Casters

Rear WheelNo selection needed with One Arm Drive

Page 7: q OPTION 1: Setup By Ki Mobility Frame Width

Removable Side Guard

q Composite Side Guards K0108 ____________________________________________________ $140Not available with T-Arm or Dual Post Flip Back Armrests

Accessories

Anti-Tip

q Rear Anti-Tips E0971 _______________________________________________________________________ $150Required with Reclining Backrest or Vent Tray

q Omit Rear Anti-Tips ____________________________________________________________________________ N/C

Frame Color

Matte FinishGloss Finish

q Charcoal Gray _____________________________________________________________________________________ N/Cq Emerald Green ____________________________________________________________________________________ N/Cq Iridescent Burgundy __________________________________________________________________________ N/Cq Iridescent Navy ___________________________________________________________________________________ N/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 Orange __________________________________________________________________________________ N/Cq Yellow ____________________________________________________________________________________________________ N/C

Pelvic Positioning Belt

q 1 1/2” Auto Buckle E0978 ________________________________________________________________ $80q 1 1/2” Padded Auto Buckle E0978 _____________________________________________ $170q 2” Airline Buckle E0978 ___________________________________________________________________ $110

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

Other Accessories

q Tool Kit ___________________________________________________________________________________________________ $55q Removable Underseat Pouch ________________________________________________________ $50q Ki Mobility Backpack ________________________________________________________________________ $65q Black Neoprene Impact Guards ____________________________________________________ $90q Clear Spoke Guards K0065 ___________________________________________________________ $115

Available only with Spoke wheel

q Black Spoke Guards K0065 __________________________________________________________ $115Available only with Spoke wheel

q Tilt Stop (Pair) K0108 _________________________________________________________________________ $30Included with Offset Hanger and Power Tilt

q IV Pole _________________________________________________________________________________________________ $275q Canopy with Hardware K0108 ______________________________________________________ $280

Not available on frame widths greater than 18”. See image below.Belt Mounting Kit

q Ki Mobility Belt Mounting Brackets ______________________________________________ $50q Bodypoint 1” Band Clamp Belt Mounting Kit _________________________ $105

O2 Holder

q O2 Holder E2208 _______________________________________________________________________________ $170Not available with Reclining Backrest or Seating Dynamics Rocker Back

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

[email protected] | www.kimobility.com

DCN0031.34 Pricing and specifications subject to change without noticePage 7 of 7

Armrests

Canopy Height Above Hardware

14”

Hardware mounts on vertical part of back cane.

ArmrestHeight Adjustable T-Arm (8.5”-13.5”) E0973

Not available with 400 lb Weight Capacity

q Desk _______________________________________________________________________________________ $285q Full __________________________________________________________________________________________ $285

Height Adjustable T-Arm Low (6.5”-10.5”) E0973Not available with 400 lb Weight Capacity

q Desk _______________________________________________________________________________________ $285q Full ___________________________________________________________________________________________ $285

Height Adj. Dual Post Flip Back (9.5”-14.5”) E0973Not available with IV Pole

q Desk ________________________________________________________________________________________ $295q Full ___________________________________________________________________________________________ $295

Angle Adjustable Locking Extendable Flip Up E0973Not available with Seating Dynamics Rocker Back or 400 lb Weight Capacity. Minimum armrest height with Reclining Backrest is 12”.

q Desk ________________________________________________________________________________________ $275q Full ___________________________________________________________________________________________ $275

q Omit Armrests _____________________________________________________________________________________ N/C

Armrest Pad

q Standard Arm Pad _____________________________________________________________________________ N/Cq Waterfall Arm Pad ____________________________________________________________________________ $25

Not available with Angle Adjuststable Locking Extendable Flip Up Armrests

q Foam Grip ____________________________________________________________________________________________ N/CAvailable only with Angle Adjustable Locking Extendable Flip Up Armrest

Military PatchUS 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

Page 8: q OPTION 1: Setup By Ki Mobility Frame Width

DCN0537.2 Pricing and specifications subject to change without notice Page 1 of 2

Axiom Cushions

Axiom G Cushion and Extra Outer Cover

Width14” 15” 16” 17” 18” 19” 20” 22”

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

Retail $120 $75 $120 $75 $120 $75 $120 $75 $120 $75 $120 $75 $120 $75 $199 $75HCPC E2601 E2601 E2601 E2601 E2601 E2601 E2601 E2602

Dep

th

14” q q15” q q q q q q16” q q q q q q q q q q q q q q17” q q q q q q q q q q q q q q18” q q q q q q q q q q q q q q q q19” q q q q q q q q q q q q q q20” q q q q q q q q q q q q q q21” q q q q q q q q q q22” q q q q q q q q q q

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

[email protected] | www.kimobility.com

Axiom S Cushion and Extra Outer Cover

Width14” 15” 16” 17” 18” 19” 20” 22”

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

Retail $210 $85 $210 $85 $210 $85 $210 $85 $210 $85 $210 $85 $210 $85 $315 $85HCPC E2603 E2603 E2603 E2603 E2603 E2603 E2603 E2604

Dep

th

14” q q15” q q q q q q16” q q q q q q q q q q q q q q17” q q q q q q q q q q q q q q18” q q q q q q q q q q q q q q q q19” q q q q q q q q q q q q q q20” q q q q q q q q q q q q q q21” q q q q q q q q q q22” q q q q q q q q q q

Axiom P Cushion and Extra Outer Cover

Width14” 15” 16” 17” 18” 19” 20” 22”

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

CushionOuter Cover

Retail $355 $95 $355 $95 $355 $95 $355 $95 $355 $95 $355 $95 $355 $95 $460 $95HCPC E2605 E2605 E2605 E2605 E2605 E2605 E2605 E2606

Dep

th

14” q q15” q q q q q q16” q q q q q q q q q q q q q q17” q q q q q q q q q q q q q q18” q q q q q q q q q q q q q q q q19” q q q q q q q q q q q q q q20” q q q q q q q q q q q q q q21” q q q q q q q q q q22” q q q q q q q q q q

Weight capacity: 350 lbs

Page 9: q OPTION 1: Setup By Ki Mobility Frame Width

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

[email protected] | www.kimobility.com

DCN0537.2 Pricing and specifications subject to change without notice Page 2 of 2

Axiom Cushions continued Weight capacity: 350 lbs

Axiom SP Visco Cushion and Extra Inner / Outer Cover

Width14” 15” 16” 17” 18” 19” 20” 21” 22”

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer

Retail $430 $105 $430 $105 $430 $105 $430 $105 $430 $105 $430 $105 $430 $105 $525 $105 $525 $105HCPC E2607 E2607 E2607 E2607 E2607 E2607 E2607 E2607 E2608

Dep

th

14” q q q q q q q q q15” q q q q q q q q q q q q q q q16” q q q q q q q q q q q q q q q q q q q q q q q q17” q q q q q q q q q q q q q q q q q q q q q q q q18” q q q q q q q q q q q q q q q q q q q q q q q q q q q19” q q q q q q q q q q q q q q q q q q q q q q q q q q q20” q q q q q q q q q q q q q q q q q q q q q q q q q q q21” q q q q q q q q q q q q q q q q q q q q q q q q22” q q q q q q q q q q q q q q q q q q q q q q q q

Axiom SP Fluid Cushion and Extra Inner / Outer Cover

Width14” 15” 16” 17” 18” 19” 20” 21” 22”

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

CushionCover

Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer Inner Outer

Retail $470 $105 $470 $105 $470 $105 $470 $105 $470 $105 $470 $105 $470 $105 $575 $105 $575 $105HCPC E2607 E2607 E2607 E2607 E2607 E2607 E2607 E2607 E2608

Dep

th

14” q q q q q q q q q15” q q q q q q q q q q q q q q q16” q q q q q q q q q q q q q q q q q q q q q q q q17” q q q q q q q q q q q q q q q q q q q q q q q q18” q q q q q q q q q q q q q q q q q q q q q q q q q q q19” q q q q q q q q q q q q q q q q q q q q q q q q q q q20” q q q q q q q q q q q q q q q q q q q q q q q q q q q21” q q q q q q q q q q q q q q q q q q q q q q q q22” q q q q q q q q q q q q q q q q q q q q q q q q

Width

14” 15” 16” 17” 18” 19” 20” 21” 22”

Dep

th

14” q q q15” q q q q16” q q q q q q q q17” q q q q q q q q18” q q q q q q q q q19” q q q q q q q q q20” q q q q q q q q q21” q q q q q q q q22” q q q q q q q q

Select size in chart below. Weight capacity: 350 lbs.

Solid Seat Insert ________________________________________________________________________________________ $60

Solid Seat Insert

Page 10: q OPTION 1: Setup By Ki Mobility Frame Width

DCN0538.4 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 $560 $560 $560 $560 $560 $795

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 $640 $640 $640 $640 $640 $870

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

Page 11: q OPTION 1: Setup By Ki Mobility Frame Width

DCN0538.4 Pricing and specifications subject to change without notice Page 2 of 5

Width

12” 14” 16” 18” 20” 22”Retail $740 $740 $740 $740 $740 $820

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 $740 $740 $740 $740 $740 $820

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

Page 12: q OPTION 1: Setup By Ki Mobility Frame Width

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

DCN0538.4 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

Page 13: q OPTION 1: Setup By Ki Mobility Frame Width

DCN0538.4 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 HCPC Retail

q Lumbar Pad K0108 $48

Lumbar Pads

Description HCPC Retail

q Privacy Flap 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

Axiom Lateral Support Modifications

Extended lead times will apply. Modified Lateral Supports are not eligible for refund.

Description Item Code HCPC Retail

q Modification for Chest Strap attached to Lateral Supports AXMLATMT K0108 N/C

Description Item Code HCPC Retail

qShoulder Strap Guides and Mount

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

AXBSG K0108 $75

Shoulder Guides

Page 14: q OPTION 1: Setup By Ki Mobility Frame Width

DCN0538.4 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 Guides AXMSG K0108 N/C

Axiom Back Modifications

Gloss Finish Item Code Retail

q Black AXMBLK N/C

q Blue Skies AXMSKY N/C

q Bubblegum Pink AXMPNK N/C

q Candy Blue AXMCBL N/C

q Candy Purple AXMPUR N/C

q Candy Red AXMRED N/C

q Copper AXMCOP N/C

q Granny Smith AXMGSM N/C

q Metallic Orange AXMMOR N/C

q Silver AXMSIL N/C

q Teal AXMTEA N/C

q Yellow AXMYLW N/C

Painted Back Shell ModificationIf no selection is made, standard Shadow Black will be used with no additional lead time

Axiom Back Modifications Extended lead times will apply for all modifications. Makes back non-refundable.

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