quantum 1450 with tru-balance bariatric power tilt order form · 4.1b. expandable controls -...

of 11INFINFB3975/RevB/06MAY2019

Quantum 1450 Order Form with TRU-Balance® Bariatric Tilt

Quantum® Rehab401 York Ave., Duryea, PA 18642Phone: 866-800-2002 | Fax: 866-707-3422 | Email: [email protected]

Account Number: ___________ Date: ________________

Provider Name: __________________________________

Contact: ________________________________________

Phone: ___________________ Fax: _________________

Email: __________________________________________

PO Number: _____________________________________

Marked for: _____________________________________

Ship to Address: _________________________________

City: _____________________ State: ______ Zip: ______

Weight:________ Height:________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

A. Shoulder Width: ________B. Chest Width: ___________C. Hip Width: _____________

D. Max Sitting Height: ______E. Shoulder Height: ________F. Axilla Height: __________

G. Thigh Depth: ___________H. Lower Leg Length: ______I. Elbow Height: __________

This form is interactive when viewed with Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat. Com-plete the form by placing checks in the desired boxes and provide information in the interactive fields. Buttons shown at the bottom of the form may be utilized to print or submit the order form through a desktop email application. To email via a web-based application, please ‘Save As’ and attach the PDF to your email. This order form contains a large variety of options to fulfill various patient needs. Descriptions and section notes, such as optional or required, are included to help you complete your order. Please contact Quantum Sales at 866-800-2002 if assistance is needed. Send the completed order form by fax (866-707-3422) or email ([email protected]). Incomplete forms may delay the quote or order. Customer service will contact you if the order is incomplete or if there are compatibility issues. If special order requests are needed, be sure that the Patient Information section is completed or include a completed physical assessment form with this order form. HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers are responsible for deter-mining the appropriate billing codes when submitting for insurance reimbursement. Payer coding, coverage, and bundling guidelines may apply. All prices are MSRP. Prices, specifications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available when configured as a complete power chair. Please contact technical service for accurate parts ordering. Options noted with "XRef" have multiple possible part numbers based on system configuration. Please see cross-reference spreadsheet for the XRef part numbers.

Thank you for choosing Quantum!

INTRODUCTION

PATIENT INFORMATION

1. BASE MODELREQUIRED. Select a group 3 power base. 600 lb. weight capacity with standard 14" flat free tires, 4.5 mph motors, and 8 amp off board charger. Dimensions of base without legrests: 29.25”W x 38.25”L.

Quantum 1450 3SPVHD-SS ...........................................................................................................................................$11,095Part: Q1450 3SPVHD-SS. HCPCS: K0860Single power option.

https://get.adobe.com/reader/

http://www.quantumrehab.com/resources/downloadorderforms.php?f=seating/us_physical_assessment_form.pdf


1. Q-Logic 2 Required ComponentsQ-Logic 2 expandable controls require the controller module and expandable harness below. If a Q-Logic joystick or specialty control is selected later in this form, Customer Service will quote the order with these items.

2. Q-Logic 2 Joystick

3. Q-Logic 2 Joystick ArmorREQUIRED with Q-Logic 2 EX Joystick selection above. Reference colors shown in section 2.

Stand Alone Joystick

Q-Logic 2 EXController Module

4.1b. Expandable Controls - Quantum Intelligent Systems™Select expandable controls or omit selection if another controller type is desired. Expandable controls allow multiple or specialized controllers. This sections allows a selection of common configurations.

Black, Soft Touch ....................................StandardPart: DGN124307

Non-matching Joystick Armor .......................... $50Part: PTOINDV3422Select color below

Match Joystick Armor to Base Color ................... $50Part: PTOINDV3421

Red CorvettePart: DGN124336-PRD1

Electric BluePart: DGN124336-PBU9

Back in BlackPart: DGN124336-PBK1

White SatinPart: DGN124336-PWH2

Pretty in PinkPart: DGN124336-PPK3

Deep PurplePart: DGN124336-PPR5

Lime LightPart: DGN124336-PGN7

Grey StreetPart: DGN124336-PSL3

Silver BulletPart: DGN124336-PSL7

Midnight BluePart: DGN124336-PBU10

Orange CrushPart: DGN124336-POR6

Yellow BlazePart: DGN124336-PYL3

Q-Logic 2 EX Controller Module .......................$695Tilt thru toggle part: ELE136029. Tilt thru joystick part: ELE136030. HCPCS: E2377

Q-Logic 2 Expandable Controller Harness ...........$425Part: DWR1111H065. HCPCS: E2313

Q-Logic 2 EX Joystick ....................................$700Part: CTL123217

Q-Logic 2 EX Joystick for Full Lights .................$700Part: CTL124653

No Joystick, Setup for Q-LogicPart: Configuration selection.

Stand Alone Joystick with ..............................$700External Charger PortPart: ELEASMB5205Up to 3 drive profiles and 1 seating profile when used alone. Use in conjunction with Enhanced Display for up to 5 profiles and auxiliary functions such as Bluetooth Mouse and IR. Includes charger port mounting bracket and multiplier box harness.

Heavy Duty, 17"Wx13"D, Foot Platform ......................... StandardPart: FRMASMB17955

Heavy Duty, 17"Wx16"D, Foot Platform ....................... No ChargePart: FRMASMB17956

Omit Base Mounted Foot Platform ............................. No ChargePart: PTOINDV3674

VR2 6-Key Joystick .................................................. StandardPart: CTLDC1498

No Joystick, Setup for VR2 Joystick ........................... No ChargePart: Configuration selection

2. BASE COLORREQUIRED. Select one shroud color. Colors shown here may differ from actual product depending on monitor/printer calibration used.

3. BASE MOUNTED FOOT PLATFORMREQUIRED. Select a foot platform option. May interfere with seat mounted legrests.

Account Number: ___________ Date: ________________ Marked for: _____________________________________

4. ELECTRONICSREQUIRED. Select a type of drive control from the following sections. The No Joystick option is used to omit the joystick and utilize another control, such as a specialty control at the end of this form or found on the Alternative Controls and Electronics Order Forms.

4.1a. Non-Expandable ControlsSelect a joystick below or omit selection if another controller type is desired. Non-expandable does not allow supplementary drive controllers.

Candy Apple RedPart: SHDASMB6684

Viper BluePart: SHDASMB6685

Onyx BlackPart: SHDASMB6686

Sunburst OrangePart: SHDASMB6688

Pearl PinkPart: SHDASMB6695

SilverPart: SHDASMB6689

Emerald GreenPart: SHDASMB6699

Sapphire Blue Part: SHDASMB6701

Orion YellowPart: SHDASMB7110017

True BluePart: SHDASMB7110018

To Be DeterminedPart: N/A

Q-Logic 2 EX Joystick

Mushroom Handle (B) ..................................... $85Part: ACCASMB1860. HCPCS: E2323

Chin Cup (C) ................................................. $85Part: ACCASMB1861.HCPCS: E2323. (E2324 when chin control)

T-Bar (D) .................................................... $120Part: ACCASMB1858. HCPCS: E2323

Medium Ball Handle (E) ................................... $65Part: ACCASMB1859. HCPCS: E2323

Soft Ball Handle (F) ........................................ $65Part: ACCASMB1856. HCPCS: E2323

Extended I-Handle (G) .................................... $85Part: ACCASMB1857. HCPCS: E2323

Bodypoint 3” Goal Post Handle ......................... $99Part: PLSKNCP1057. HCPCS: E2323

Bodypoint 4” Goal Post Handle ......................... $99Part: PLSKNCP1058. HCPCS: E2323

Joystick Handles

5. JOYSTICK HANDLESREQUIRED. The Q-Logic 2 EX joysticks are standard with a carrot handle (See A in image). The optional handle will be mounted to the joystick and the standard handle will be shipped with the unit.

http://www.quantumrehab.com/resources/downloadorderforms.php?f=electronics/us_alternative_controls_order_form.pdf


6.1b. Swing-Away (Retractable) Joystick BracketAllows the joystick to retract to the side of the armrest while maintaining the same joystick orientation. "Inline bracket" is used with track/TRU-Balance 3 style arms (not on this order form) when the joystick is inline with armpad. "Inline bracket" will be offset 1" when used with tube style arms. Select "Offset Bracket" to have the joystick inline with armpad on tube style armrests.

Swing-away, Inline, Left Side Mount ..................$245VR2 Part: ACC142529. Q-Logic: ACC142524. HCPCS: E1028

Swing-away, Inline, Right Side Mount ................$245VR2 Part: ACC142530. Q-Logic: ACC142525. HCPCS: E1028

Swing-away, 1” Offset, Left Side Mount .............$245VR2 Part: ACC142749. Q-Logic: ACC142742. HCPCS: E1028

Swing-away, 1” Offset, Right Side Mount ............$245VR2 Part: ACC142750. Q-Logic: ACC142743. HCPCS: E1028

Multi-Axis JoystickMount

Retract4

6.1a. Fixed, In-line Joystick Bracket


6. JOYSTICK MOUNTING BRACKETSOptional. Select a mount to be used with a joystick selected in previous section.

Omit Joystick Mounting Bracket

Fixed, In-line, Bracket .............................................................................................................StandardQ-Logic Part: FRMASMB10617. VR2 Part: FRMASMB9532

Left Side MountPart: PTOINDV1225

Right Side MountPart: PTOINDV1226

Swing Away JoystickInline Mount (Right)

Swing Away JoystickOffset Mount (Right)

Q-Logic EX/NE Programmer ............................................ $545Part: ELEASMB6976

Q-Logic PC Programming Disk with Cable ........................... $750Part: ELEASMB5216

7. ELECTRONICS ACCESSORIESOptional.

8. TRU-BALANCE BARIATRIC POWER TILTREQUIRED.

8.1. Bariatric Tilt Seating

8.3. Seat Dimension - Width PackageREQUIRED.

8.2. Seat Dimension - WidthREQUIRED. Maximum seat width is 32". Part number is SETWDTH plus number following # below.

8.4. Seat Dimension - DepthREQUIRED. Maximum seat depth is 28". Part number is SETDPTH plus number following # below.

8.5. Seat Dimension - Depth PackageREQUIRED.

TRU-Balance bariatric power tilt section continued on following pages.

6.1c. Specialty Joystick MountsSelect a bracket and side to mount it.

Specialty Mount Side

Retract4 Mount ............................................$350Q-Logic Part: MEC138860. HCPCS: E1028Not available with VR2 joystick. Full 180° of movement that translates into multi-position use, straight, right off-set, left offset, or fold away. Joystick orientation varies as bracket is adjusted.

Multi-axis Mount ..........................................$100VR2 Part: ACC142531. HCPCS: E1028Q-Logic Part: ACC131216. HCPCS: E1028Allows height adjustment of joystick.

Stealth Swing-Away/Flip Down Bracket ..........$294.25Q-Logic Part: ST-TWBM480QL-Q. HCPCS: E1028SAJ Part: ST-TWBM480CJ-Q. HCPCS: E1028Not available with VR2 joystick. Allows the joystick to pivot to side of armrest, or flip-down if bracket is ad-justed.

Left Side MountPart: PTOINDV1225

Right Side MountPart: PTOINDV1226

TRU-Balance Bariatric Power Tilt ................................................................................................................................... $7,250Part: PTOINDV3263. HCPCS: E100240° center of gravity power tilt.

20”-24” Width PackagePart: MEC120322



20” D(#1010)

21” D(#1011)

22” D(#1012)

23” D(#1013)

24” D(#1014)

25” D(#1060)

26” D(#1061)

27” D(#1062)

28” D(#1063)

20” W(#1010)

21” W(#1011)

22” W(#1012)

23” W(#1013)

24” W(#1014)

25” W(#1056)

26” W(#1054)

27” W(#1057)

28” W(#1055)

29” W(#1058)

30” W(#1059)

31” W(#1060)

32” W(#1061)

20”-24” Depth PackagePart: FRMASMB10524

24”-28” Depth PackagePart: MEC147637


Synergy Back ............................................................... $275Part: See XRefSelect a back cane type and height and back height.

Omit Back ............................................................ No ChargePart: PTOINDV1287Select a back cane type and height in following section.


2. Back Selection

TRU-Balance bariatric power tilt section continued on following page.

4. Back Cane Type SelectionSynergy Back Cane ................................................ No ChargePart: FRMASMB15844Select a back cane height.

2” Mesomorph (1” per side) Back Cane ...............................$195Part: FRMASMB12067Select a cane height.

4” Mesomorph (2” per side) Back Cane ...............................$195Part: FRMASMB12091Select a cane height.

2” Endomorph (1” per side) Back Cane ...............................$195Part: FRMASMB12115Select a cane height.

4” Endomorph (2” per side) Back Cane ...............................$195Part: FRMASMB12139Select a cane height.

3. Push HandlesPush Handles .......................................................... StandardPart: Configuration selection with back cane height

Omit Push Handles .........................................................$125Part: Configuration selection with back cane height

8.7. Seat to Floor HeightREQUIRED.

5. Overall Back HeightRefer to the TRU-Balance Bariatric Power Tilt back availability chart for stock order back size ranges. Parts: See XRef, configuration selection with back se-lection.

17” Overall High Back18” Overall High Back19” Overall High Back20” Overall High Back21” Overall High Back

22” Overall High Back23” Overall High Back24” Overall High Back25” Overall High Back

18.50" STFPart: PTOINDV3463



Full Length, Bariatric Armrests, 8"-12" H ................ No ChargeLeft part: FRMASMB6728. Right part: FRMASMB6729

Full Length, Bariatric Armrests, 10"-14"H ............... No ChargeLeft part: FRMASMB6730. Right part: FRMASMB6731.

8.8. Bariatric Tilt ArmrestsREQUIRED. Left (L) and right (R) boxes may be checked to configure different size arms within one section arm type.1a. Bariatric, Single Post, Heavy Duty, Height Adjustable, Removable ArmrestsMay interfere with swing-away laterals.

Full Length, Heavy Duty Armrests, 8"-12" H ............ No ChargeLeft part: FRMASMB9982. Right part: FRMASMB9983

Desk Length, Heavy Duty Armrests, 8"-12"H ............ No ChargeLeft part: FRMASMB9984. Right part: FRMASMB9985

Full Length, Heavy Duty Armrests, 10"-14" H ........... No ChargeLeft part: FRMASMB9986. Right part: FRMASMB9987

Desk Length, Heavy Duty Armrests, 10"-14"H .......... No ChargeLeft part: FRMASMB9988. Right part: FRMASMB9989

1b. Single-Post, Heavy Duty, 8"-12" Height Adjustable, Removable Armrests

1c. Single-Post, Heavy Duty, 10"-14" Height Adjustable, Removable Armrests

1d. Cantilever, Height Adjustable ArmrestsHeight adjustment from 11"-17" depends on cane height. Angle adjustable from -30° to +30°.

Full Length, Cantilever Armrests .......................... $97.50 ea.Left Part: FRMASMB16188. Right part: FRMASMB16189

Desk Length, Cantilever Armrests ......................... $97.50 ea.Left part: FRMASMB16190. Right part: FRMASMB16191

8.6. Bariatric Tilt Back OptionsREQUIRED. See the TRU-Balance Bariatric Power Tilt back availability chart for stock order back size ranges. Other size backs may be available with special order and extended lead time.1. Back Cane HeightParts: See XRef, configuration selection with push handles selection.

18” High Canes19” High Canes




8. TRU-BALANCE BARIATRIC POWER TILT continued



8. TRU-BALANCE BARIATRIC POWER TILT continued8.9. Armrest HeightREQUIRED. Set left and right armrest height. Note the available height range in the option description.

8” HPTOINDV3535

9” HPTOINDV3536

10” HPTOINDV3537

11” HPTOINDV3538

12” HPTOINDV3539

13” HPTOINDV3540

14” HPTOINDV3541

15” HPTOINDV3542

16” HPTOINDV3543

8” HPTOINDV3450

9” HPTOINDV3451

10” HPTOINDV3452

11” HPTOINDV3453

12” HPTOINDV3454

13” HPTOINDV3455

14” HPTOINDV3456

15” HPTOINDV3457

16” HPTOINDV3458

1. Left Armrest Height

2. Right Armrest Height

Bariatric Armpads ................................................. No ChargePart: UPSASMB1025Only available with bariatric armrests.

Straight Armpads ................................................... No ChargeDesk/Desk part: UPSASMB1022. Full/Full part: UPSASMB1021. Desk/Full part: UPSASMB1023Not available with bariatric armrests.

Waterfall Armpads ................................................. No ChargeDesk/Desk part: UPSASMB1025. Full/Full part: UPSASMB1024. Desk/Full part: UPSASMB1026May interfere with seat back. Not available with bariatric armrests.

Omit Armpads ...................................................... No ChargePart: PTOINDV1373

8.10. Bariatric Tilt ArmpadsREQUIRED with armrest selection above. Armpads are configured as pairs.

9. JOYSTICK BRACKET RECEIVERREQUIRED.

Standard Fixed Receiver ...........................StandardPart: ACC123525

Stealth Height Adjustable Receiver ................... $214Part: ST-ARM250C-Q. HCPCS: K0108

Height Adj. Receiver

Single Actuator Through Q-Logic 2 .................$1,895Controller and Interface (AM1)Part: ELEASMB7218. HCPCS: E2310

Single Actuator Through Q-Logic 2 ................ $2,895Controller and Interface (AAM)Part: ELEASMB7217. HCPCS: E2310

4 Way TogglePart: ELEASMB5925

4 Way Button TogglePart: ELEASMB5926

Quad Push ButtonPart: ELEASMB5924

10. TRU-BALANCE 3 POWER POSITIONING ELECTRONICSREQUIRED.

10.1c. Q-Logic 2 Controls through Joystick

Single Actuator Control, Power Tilt Through Toggle ........................................................................................................No ChargePart: ELEASMB6395Select a side to mount toggle.

Left Side Toggle Right Side TogglePart: ELEASMB5156 Part: ELEASMB5157

10.1a. Tilt Only through Toggle

Q-Logic 2 Optional Switch ControlNot available with AM1 electronics. Switch will be mounted to same side of joystick.

10.1b. VR2 through JoystickSingle Actuator Control Through VR2 Joystick ................................................................................................................... $1,895Part: ELE132816. HCPCS: E2310

Switch Controls

4 Way Toggle

4 Way ButtonToggle

Quad PushButton

Seat Mounted, LED, Full Light Package ...............................................................................................................................$995Part: ELE131477

Accessory Bar ...............................................................................................................................................................$10016"W-20"W part: MEC143975. 20"-24" part: MEC146018. 24"-28" part: MEC146050. 28"-32" part: MEC146051.

11. FULL LIGHT PACKAGEOptional. Requires Q-Logic 2 Joystick for Full Light Package.

12. ACCESSORY BAROptional.



Legrests section continued on following page.

Headrests

14.1. Headrest Pads

14.2. Headrest Brackets

14. HEADRESTSOptional. Select a headrest pad and bracket.

Stealth’s Worlds Best Removable ..................$220.50Headrest Bracket (TWB485-1) (C)Part: FRMASMB15999. HCPCS: E1028

Stealth Multi-Axis Removable Headrest..........$160.50Bracket (HMO475P) (D)Part: HDWASMB1084. HCPCS: E1028

Stealth 8” Comfort Plus (CP450) ................... $151.94Part: POS148484. HCPCS: E0955

Stealth 10” Comfort Plus (CP250)(A) ............. $151.94Part: SETHEAD1057. HCPCS: E0955

Stealth 14” Comfort Plus (CP150) ................. $151.94Part: INDPART2327. HCPCS: E0955

Pediatric Comfort Plus (6”Wx4.5”H) ............. $151.94(CPN350)Part: SETHEAD1069. HCPCS: E0955

Stealth Small Contoured (9.75”Wx3”H) .............$64.20(STL-OTSM250)Part: SETHEAD1052. HCPCS: E0955

Stealth Large Contoured (11”Wx6”H) (B) ........... $80.25(STL-OTLG150)Part: SETHEAD1053. HCPCS: E0955

38” Lap BeltPart: ACCBELT1006






i-Fit 60” Single Pull, Push Button, Medium ...........................$86(7.5”) Padded, 1.5” Belt (IFPB5213)Part: ST-IFPB5213-Q

i-Fit 60” Single Pull, Push Button, Large ..............................$86Padded (9.5”), 2” Belt (IFPB5314)Part: ST-IFPB5314-Q

i-Fit 60” Single Pull, Push Button, Extra Large ......................$86Padded (11.5”), 2” Belt (IFPB5315)Part: ST-IFPB5315-Q

13.1a. Standard Lap Belts

13.1b. Optional Lap Belts

13. LAP BELTSREQUIRED. Select a lap belt below.

Center Mount Foot Platform ............................................................................................................................................ $25020"-24"W part: RIG155637. 24"-28"W part: RIG155527. 28"-23"W part: RIG155528

15.1. Manually Adjustable Center Mount Foot Platform

17"Wx13"D One Piece Foot PlatformPart: RIG123289

17"Wx16"D One Piece Foot PlatformPart: RIGASMB7120011

2. Footplates

1. Foot Platform Assembly

Reversed Dartex Calf Pad Cover (pair) ............................... $150Part: RIG133719

Reversed Dartex Panel Cover (pair) .................................. $150Part: RIG134744

Wheel Bumpers (pair) ............................................. $12.50 ea.Part: WHLASMB1578 x2

Footplate Connector ....................................................... $15Part: RIGASMB7120023

4. Additional Accessories

3. Center Mount Calf SupportCalf pad and panel covers include 1/2” of soft visco foam.

Large Calf Pads (pair) 8” taper to 6”Wx8”H ........................ $150Part: RIGASMB7120019

Large Calf Panel 24”Wx8”H ............................................ $200Part: RIG123824

15.2. Heavy Duty, Drop-In, Swing-Away LegrestsSelect a configuration, a legrest with extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.1. Drop-In Legrest Selection

2. Angle Adjustable Footplate(s) with Heel Loops

3. Accessories

70° HD Drop-in with 12"-14.5" Length ............... No ChargeLower ExtensionPair part: FRMASMB4762. Left: RIG137706. Right: RIG137707

70° HD Drop-in with 14.5-18" Length ............... No ChargeLower ExtensionPair part: FRMASMB4853. Left: RIG137708. Right: RIG137709

6”Wx8”D1 ......................................................$85 ea.Pair part: FRMASMB4738. Left: RIG137793. Right: RIG137795.HCPCS: K0040+E0951

6”Wx11”D1 .....................................................$85 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797.HCPCS: K0040+E0951

8”Wx11”D2 .....................................................$85 ea.Pair part: FRMASMB4744. Left: RIG137708. Right: RIG137709.HCPCS: K0040+E0951

Wheel Bumper(s) ..........................................................................................................................................$12.50 ea.Pair part: WHLASMB1578. Left part: WHL169510. Right part: WHL169511

15. LEGRESTSOptional. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. Reference the section’s compatibility matrix for legrest interference.



15. LEGRESTS continued

1. Heavy Duty, Elevating Legrest Selection

2. Lower Extension

3. Reinforced Footplates(s)

4. Angle Adjustable Footplates(s) with Heel Loops

Heavy Duty, Elevating Legrest(s) with Calf Pad(s) ................................................................................................ $162.50 ea.Pair part: FRMASMB6702. Left: FRMASMB8444. Right: FRMASMB8445. HCPCS: E0990

7.25”Wx6”D Extruded Footplate ........................ StandardPart pair: FRMASMB4748. Left: RIG138055. Right: RIG138056

8.5”Wx6”D Extruded Footplate ......................... StandardPart pair: FRMASMB4747. Left: RIG138060. Right: RIG138062

6”Wx8”D .......................................................$85 ea.Pair part: FRMASMB4738. Left: RIG137793. Right: RIG137795.HCPCS: K0040+E0953

6”Wx11”D ......................................................$85 ea.Pair part: FRMASMB4741. Left: RIG137796. Right: RIG137797.HCPCS: K0040+E0953

8”Wx11”D ......................................................$85 ea.Pair part: FRMASMB4744. Left: RIG137798. Right: RIG137799.HCPCS: K0040+E0953May cause interference with seat widths less than 20"

11”-14” LengthPart: FRMASMB4755. Left: RIG138026. Right: RIG138030For reinforced footplates only.

12”-14.5” LengthPart: FRMASMB4752. Left: FRMASMB5391. Right: FRMASMB4723For angle adjustable footplates only.

14”-17” LengthPart: FRMASMB4756. Left: RIG138033. Right: RIG138035For reinforced footplates only.

14.5”-18” LengthPart: FRMASMB4753. Left: FRMASMB4724. Right: FRMASMB5392For angle adjustable footplates only.

15.3. Heavy Duty, Elevating LegrestsSelect a configuration, a legrest with extension, and type of footplate. Pair (P), left (L), and right (R) configurations are selected by checking the appropriate boxes.

7” L(#3470)

7.5” L(#3471)

8” L(#3472)

8.5” L(#3473)

9” L(#3474)

9.5” L(#3475)

10” L(#3476)

10.5” L(#3477)

11” L(#3478)

11.5” L(#3479)

12” L(#3480)

12.5” L(#3481)

13” L(#3482)

13.5” L(#3483)

14” L(#3484)

14.5” L(#3485)

15” L(#3486)

15.5” L(#3487)

16” L(#3488)

16.5” L(#3489)

17” L(#3490)

17.5” L(#3491)

18” L(#3492)

18.5” L(#3493)

19” L(#3494)

19.5” L(#3495)

20” L(#3496)

20.5” L(#3497)

21” L(#3498)

21.5” L(#3600)

22” L(#3669)

22.5” L(#3670)

16. SET LEGREST LENGTHREQUIRED with matching left and right legrest configuration. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guidelines. Some adjustments may be needed upon receipt of the unit. Non-matching or individual legrest configurations lengths are not set by the manufacturer.

17.1. Seat Cushion Model Selection

17. SEAT CUSHIONOptional. Specific cushion/component sizes available, part numbers, and special order cushions can be found on the respective complete Stealth Cushion Order Forms. This section allows a quick selection of a single cushion. The XXYY portion of the part number directly relates to the dimensions of the cushion, where XX represents the width and YY represents the depth.

TRU-Comfort 2 SPP, E2607, 20"W .....................$400TRU-Comfort 2 SPP, E2608, 22"W .....................$500

Simplicity G, E2601, 20"W .............................. $110Simplicity G, E2602, 22"W to 24"W ................... $165

Spectrum Gel SPP, E2607, 20"W .......................$460Spectrum Gel SPP, E2608, 22"W to 24"W ...........$530

Spectrum Foam SPP, E2607, 20"W ....................$460Spectrum Foam SPP, E2608, 22"W to 32"W .........$530

Stealth Simplicity G CushionGeneral use cushion with Stealth Tek 2, 2-way stretch, breathable cover. Weight capacity for 16" to 20" W is 350 lbs, over 20"W is 400 lbs.Part series: ST-SIMGXXYY

Stealth Spectrum Gel SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner. Weight capacity for 20" W is 350 lbs, over 20"W is 550 lbs.Part series: ST-SPCGSPPXXYY

Stealth TRU-Comfort 2 SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Weight capacity for 16" to 20" W is 350 lbs, over 20"W is 450 lbs.Part series: ST-TC2SPPXXYY

Stealth Spectrum Foam SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner. Weight capacity for 20" W is 350 lbs, over 20"W is 650 lbs.Part series: ST-SPCFSPPXXYY

Solution SPP, E2607, 20"W ..............................$375Solution SPP, E2608, 22"W to 24"W ..................$430

Stealth Solution SPP CushionSkin protection and positioning with Coolcore, 4-way stretch, breathable cover. Includes urethane liner. Weight capacity for 20" W is 350 lbs, over 20"W is 550 lbs.Part series: ST-SOLSPPXXYY

Glacial SP, E2603, 20"W .................................$330Glacial SP, E2604, 22"W to 24"W ......................$440

Stealth Glacial SP CushionSkin protection with Coolcore, 4-way stretch, breathable cover. Weight capacity is for 20"W is 350 lbs, over 20"W is 450 lbs.Part series: ST-GLSPXXYY

Premiere P, E2605, 20"W ...............................$325

Stealth Premiere P CushionPositioning with Coolcore, 4-way stretch, breathable cover. Weight capacity for 20"W is 350 lbs.Part series: ST-PREMPXXYY

Seat cushion section continued on following page.

https://www.quantumrehab.com/resources/quantum-order-forms.asp

https://www.quantumrehab.com/resources/quantum-order-forms.asp

https://www.quantumrehab.com/pdf/order-forms/seating/us_stealth_simplicity_order_form.pdf

https://www.quantumrehab.com/pdf/order-forms/seating/us_stealth_spectrum_foam_order_form.pdf

https://www.quantumrehab.com/pdf/order-forms/seating/us_stealth_trucomfort_2_order_form.pdf

https://www.quantumrehab.com/pdf/order-forms/seating/us_stealth_spectrum_gel_order_form.pdf

https://www.quantumrehab.com/pdf/order-forms/seating/us_stealth_solution_order_form.pdf


17.3. Seat Cushion Substitute/Add Fluid Proof Liners

17.4. Seat Cushion Substitute CoverAn additional cover may be ordered or the standard cover may be substituted with a cover by checking the option in subsection 2. The "*prefix" of the part number will be the part prefix of the cushion model selected above. For example, SPCGSPP-NBLK1816 will be an additional coolcore cover for a Spectrum Gel cushion.

17.2. Seat Cushion DimensionsREQUIRED with cushion model selection. Select to match or pick non-matching dimensions. See respective cushion order form for available sizes.

Fluid Proof Urethane Liner ......................................... $50-$70Part: URL1709070-XXYYNot available with Simplicity, or TRU-Comfort 2.

Fluid Proof Polyurethane Liner .................................... $55-$75Part: PUL1709030-XXYYNot available with Simplicity.

Match Seat Width and Depth

Stealth Tek 2 Cover ................................................ No ChargePart: *prefix-TBLKXXYYNot available with Simplicity, TRU-Comfort 2, and Premiere.

Mesh Cover .......................................................... No ChargePart: *prefix-MBLKXXYYNot available with Simplicity or TRU-Comfort 2.

Cushion Width Cushion Depth

20" W 22" W 24" W 26" W 28" W 30" W 32" W 20" D 21" D 22" D 23" D 24" D 26" D 28" D

17. SEAT CUSHION continued


Group 24, Gel Cell, Interceptor Battery ........................ $365 ea.Part: BAT1704614. HCPCS: E2363

No batteries. Provider will assume responsibility of batteries.Part: Configuration selection

Group 24, Gel Cell, MK Battery ................................... $495 ea.Part: BATGEL1009. HCPCS: E2363

19. BATTERIESREQUIRED. The powerchair requires 2 batteries and will be installed if ordered.

Oxygen Holder ............................................................. $200Part: ACC125006 HCPCS: E2208

Stealth Large Tablet Holder ............................................ $375Not available with desk length armrests.Part: ACC7120005

Stealth Deluxe Cell Phone/Media Holder .............................$195Not available with desk length armrests. Part: ACC7120006

Cup Holder .......................................................... No ChargePart: ACCASMB2634

20. BRANCH PATCHESOptional.

Air Force Patch .................. $20Part: ACC140240

Army Patch ....................... $20Part: ACC140241

Coast Guard Patch .............. $20Part: ACC140239

Marines Patch .................... $20Part: ACC140243

Navy Patch ....................... $20Part: ACC140244

Purple Heart Patch ............. $20Part: ACC140238

Military Patches

1. Bracket

2. Pads

3. Installation

Swing-away, Rail Mounts, pair (TWBTLTC) ......................$472.50Part: INDPART2896. HCPCS: E1028

Curved Pads, 3”x5”, pair (TWBL-3X5) ................................ $210Part: INDPART2663. HCPCS: E0956

Curved Pads, 4”x6”, pair (TWBL-4X6) ................................ $210Part: INDPART2664. HCPCS: E0956

Install LateralsPart: PTOINDV3499

Do Not InstallPart: PTOINDV3500

21.1. Stealth Thoracic LateralsLaterals are not available with the omit back option.

21. MANUFACTURER INSTALLED POSITIONING COMPONENTSOptional. More options are available on the Positioning Components Order Form.

18. PROVIDER INSTALLED ACCESSORIESOptional.

Manufacturer installed positioning components section continued on following page.

http://www.quantumrehab.com/resources/downloadorderforms.php?f=seating/us_positioning_components_order_form.pdf



Flip Down Bracket (TWBTLADD-HW) ................... $236.25 ea.Part: INDPART2804. HCPCS: E1028

Removable Bracket (LP430) ............................... $262.50 ea.Part: INDPART2805. HCPCS: E1028

Removable Bracket with 1” Offset .......................... $400 ea. (LP430 & LHW-121)

Part: INDPART2854. HCPCS: E1028

Flip Down with LEFT Full Surface Contact ................. $236.25 ea.Feature (TWBADD-L & LPHW407)Part: POS140428. HCPCS: E1028

Flip Down with RIGHT Full Surface Contact ................ $236.25 ea.Feature (TWBADD-R & LPHW407)Part: POS140429. HCPCS: E1028

1. Pelvic/Thigh Guide Bracket

2. Pelvic/Thigh Guide Adapter

21.3. Stealth Pelvic/Thigh GuidesPelvic/thigh guides may interfere with the joystick receiver block and down posts. Please provide quantity next to check box.

2” Height Adapter Plate (LHW-122) .................................$26.25Part: INDPART2821. HCPCS: K0108Height adapter is needed with TRU-Comfort seat cushions. Not avail-able with the flip down bracket.

2 1/4” Adapter Plate (LHW-129) .....................................$53.50Part: POS140430. HCPCS: K0108Only available with the flip down full surface bracket.

3. Pelvic/Thigh Guide Pad^Please verify the appropriate billing code to be used for this item with all third-party payors.

4. Pelvic/Thigh Guide Installation

Short Pad, 4”x4” (TWBADD-4X4) ..............................$75 ea.Part: INDPART2801. HCPCS: E0953^/E0956

Medium Pad, 4”x8” (TWBADD-4X8) ...........................$75 ea.Part: INDPART2802. HCPCS: E0953^/E0956

Long Pad, 4”x12” (TWBADD-4X12) ............................$75 ea.Part: INDPART2803. HCPCS: E0953^/E0956

Install on LeftPart: PTOINDV3585

Install on RightPart: PTOINDV3586


4. UniLink Pelvic/Thigh Guide InstallationInstall on LeftPart: PTOINDV3585

Install on RightPart: PTOINDV3586


1. UniLink Pelvic/Thigh Hardware

2. UniLink Pelvic/Thigh Pads^Please verify the appropriate billing code to be used for this item with all third-party payors.

3. UniLink Pelvic/Thigh Additional Links

21.2. Stealth UniLink Pelvic/Thigh Guide

UniLink, 5" Height Adjustable & Removable Hardware ... $245 ea.Part: ST-UTTP5-Q

UniLink, 7" Height Adjustable & Removable Hardware... $255 ea.Part: ST-UTTP7-Q

UniLink, 4" x 4" Pad ..............................$95 ea.Part: ST-UTP544056100-Q

UniLink, 4" x 8" Pad ............................. $105 ea.Part: ST-UTP548056100-Q

UniLink, 4" x 12" Pad ........................... $125 ea.Part: ST-UTP548056100-Q

UniLink, 1.5" Link ............................... $75 ea.Part: ST-UIL00I150A000-Q

UniLink, 2" Link ................................... $75 ea.Part: ST-UIL00I200A00-Q

UniLink Pad & Hardware

21. MANUFACTURER INSTALLED POSITIONING COMPONENTS continued

22.1. Stealth Foot Boxes^Please verify the appropriate billing code to be used for this item with all third-party payors.

Stealth Small Foot Boxes, 5"Wx8"Dx7"H ......................... $498.75(SPLE107) (pair)Part: INDPART2786. HCPCS: E0954^

Stealth Medium Foot Boxes, 6"Wx10"Dx9"H .................... $498.75(SPLE108) (pair)Part: INDPART2787. HCPCS: E0954^

Stealth Large Foot Boxes, 7"Wx12"Dx11"H ...................... $498.75(SPLE109) (pair)Part: INDPART2788. HCPCS: E0954^

22.2. Stealth Padded Shoe HolderStealth Small Padded Shoe Holder 3.75"Wx6.25"D ................ $266(SPLE111) (pair)Part: INDPART2783. HCPCS: E0951+E0952

Stealth Medium Padded Shoe Holder, 4"Wx8.25"D ................ $266(SPLE112) (pair)Part: INDPART2784. HCPCS: E0951+E0952

Stealth X-Large Padded Shoe Holder, 5"Wx10.75"D ............... $266(SPLE114) (pair)Part: INDPART2785. HCPCS: E0951+E0952

22. PROVIDER INSTALLED POSITIONING COMPONENTSOptional. More options are available on the Positioning Components Order Form.

Provider installed positioning components section continued on following page.



1" Ball Kit for Facial Laterals (TWB-1BK) (D) ..... $80.25Part: POS150532Required with facial laterals to mount to comfort head-rest brackets.

Egg Switch Mount (ESM) (A) ................ $52.50 ea.Part: INDPART2815

Figure 8 Bracket with 13" Rod ............ $267.50 ea. and Egg Switch Mount (B)

Part: ST-F8675-13-Q

Facial Pad, 4"x2" (900-Q)................... $53.50 ea.Part: ST-900-Q. HCPCS: K0108

Facial Pad, 6"x2" (920-Q) ................... $53.50 ea.Part: ST-920-Q. HCPCS: K0108

Swing-Away Joystick Mount, ..................$250 ea. 18" Rod (C)

Part: ST-SUS18-Q Allows mounting of facial pads and attaches to the headrest

22.4. Stealth i-Fit Chest Harness

22.5. Stealth i-Fit Chest Straps

Upper Classic, Medium (IFPS1103) ............... $142 ea.Part: ST-IFPS1103-Q. HCPCS: E0960

Upper Classic, Large (IFPS1104) .................. $142 ea.Part: ST-IFPS1104-Q. HCPCS: E0960

Upper Contour, Medium (IFPS2103) .............. $142 ea.Part: ST-IFPS2103-Q. HCPCS: E0960

Upper Contour, Large (IFPS2104) ................ $142 ea.Part: ST-IFPS2104-Q. HCPCS: E0960

Chest Strap, Medium w/ Belt Anchor ............. $90 ea.(IFCS4113)Part: ST-IFCS4113-Q. HCPCS: E0960

Chest Strap, Large w/ Belt Anchor ................ $90 ea.(IFCS4114)Part: ST-IFCS4114-Q. HCPCS: E0960

Contoured and ClassicChest Harness

Chest Strap22.6. Stealth Swing-Away Headrest MountsThese swing-away headrest mounts are only available with the Stealth Comfort Series headrests. The 1" ball kit must be selected to mount the facial lateral to the headrest bracket. Also select a facial pad(s) with the facial lateral(s).

Facial Lateral for Comfort Series .............$294.25 ea.Right Side (CPS9-R-HW)Part: INDPART2647. HCPCS: E1028

Facial Lateral for Comfort Series .............$294.25 ea.Left Side (CPS9-L-HW)Part: INDPART2648. HCPCS: E1028

Facial Laterals for Comfort Series ........... $347.75 ea.Left and Right Side (CPS9-B-HW)Part: INDPART2649. HCPCS: E1028

Left and Right FacialLateral with Pads

Headrest Accessories

2. Elbow Support Pad

1. Elbow Support Bracket22.3. Stealth Elbow Support

Left,Swing-Away, Elbow Support Bracket ..............$183.75 ea. Tube Style Arms (ARMS-ES-L)

Part: POS124064. HCPCS: E1028

Left, Fixed Elbow Support Bracket .......................$183.75 ea. TRU-Balance 3 Arms (ARMS-ESFTB3-L)

Part: POS133465

Right, Swing-Away, Elbow Support Bracket ............$183.75 ea. Tube Style Arms (ARMS-ES-R)

Part: POS124066. HCPCS: E1028

Right, Fixed Elbow Support Bracket .....................$183.75 ea. TRU-Balance 3 Arms (ARMS-ESFTB3-R)

Part: POS133466

3"Wx3"H Elbow Pad (ARMS-ES-3X3) .......................$52.50 ea.Part: POS124065. HCPCS: K0108

4"Wx4"H Elbow Pad (ARMS-ES-4X4) .......................$52.50 ea.Part: POS124067. HCPCS: K0108

Facial Lateral Pads and Accessories


Specialty controls section continued on following page.

23.1. SCIM ModuleOptional.

SCIM Module Kit for Q-Logic 2......................................................................................................... $525Part: CTL168055Available with Q-Logic 2 EX Joystick selection above. Allows use of joystick display for specialty devices and offers up to 5 profiles to control drive, seat, and auxiliary functions, excluding sip-n-puff and single switch functions. A switch is required to operate the input device attached to the SCIM module. SCIM Module

23. SPECIALTY CONTROLSOptional. Select a type of specialty controls below or to refer to the specialty controls order form.

22. PROVIDER INSTALLED POSITIONING COMPONENTS continued

23.2. Q-Logic 2 Stand Alone JoystickQ-Logic 2 EX Stand Alone Joystick ...................................................................................................$700Part: ELEASMB5205Up to 3 drive profiles and 1 seating profile when used alone. Use in conjunction with Enhanced Display for up to 5 pro-files and auxiliary functions such as Bluetooth Mouse and IR. Includes charger port mounting bracket and multiplier box harness. EX Stand Alone Joystick



23. SPECIALTY CONTROLS continued

Enhanced Display

23.3. Enhanced Display

Q-Logic 2 Enhanced Display ShroudRequired with Q-Logic 2 Enhanced Display selection above. Reference colors shown on page 2.

Red CorvettePart: DGN137729-PRD1

Electric BluePart: DGN137729-PBU9

Back in BlackPart: DGN137729-PBK1

White SatinPart: DGN137729-PWH2

Pretty in PinkPart: DGN137729-PPK3

Deep PurplePart: DGN137729-PPR5

Lime LightPart: DGN137729-PGN7

Grey StreetPart: DGN137729-PSL3

Silver BulletPart: DGN137729-PSL7

Midnight BluePart: DGN137729-PBU10

Orange CrushPart: DGN137729-POR6

Yellow BlazePart: DGN137729-PYL3

Black, Soft Touch ....................................StandardPart: DGN137728

Non-matching Joystick Shroud.......................... $50Select color below

Match Joystick Shroud to Base Color .................. $50Part: See color below

Q-Logic 2 Enhanced Display Kit .....................................................................................................$1,720Part: KIT140039Select a color option below. Includes enhanced display, flexible gooseneck and mounting bracket. Features: 3.5” LCD display; up to 5 profiles to control drive, seat, and auxiliary functions; Bluetooth connectivity for mobile devices and mouse emulation; integrated single switch scanner; IR controls.

23.4. Head ArrayAdult, i-Drive Tri-Array Series, 3-Switch ......... $4,414Head Array (IDHBT200-1)Part: ST-IDHBT200-1-Q. HCPCS: E2330Features bluetooth, head support, 3 non-proportional proximity sensors for drive control, an egg switch for re-set mode change, and i-Drive smart box.

Adult, i-Drive Pro Series Head Array .............. $4,461(IDHBT300-1)Part: ST-IDHBT300-1-Q. HCPCS: E2330Features bluetooth, head support with occipital pad and 2 swing-away spot pads for left and right side, 3 non-pro-portional proximity sensors, an egg switch for reset mode change, and i-Drive smart box.

Adult Pro-Series

23.5. Sip and Puff DriveSip and Puff Module for Q-Logic 2 ..................................................................................................$1,895Part: KITASMB1697. HCPCS: E2325 Includes module and bus cable.

Sip & Puff Module

23.6. Egg Switches

23.7. Switch Adapter

Egg Switch

Red Egg Switch (ESRED) ..................... $80.85 ea. Part: SWTMCRO1077

Blue Egg Switch (ESBLU) .................... $80.85 ea.Part: SWTMCRO1079

Black Egg Switch (ESBLK) ................... $80.85 ea.Part: SWTMCRO1081

Green Egg Switch (ESGRN) ................. $80.85 ea.Part: SWTMCRO1078

Yellow Egg Switch (ESYEL) ................. $80.85 ea.Part: SWTMCRO1080

2 to 1 Switch Adapter .................................................................................................................................................. $13.39Part: DWR1361H037 Connects 2 single switches to a stereo jack to act as a dual switch.

Alternative Controls & Electronics Order Form Positioning Components Order Form

24. REFERENCE ORDER FORMSOptional. Select below to note that additional order forms will accompany this order form. This will also be a link in interactive forms.

©2019 Quantum Rehab - A Pride Mobility Products Corporation company. All rights reserved.

Quantum® Rehab401 York Ave., Duryea, PA 18642Phone: 866-800-2002 | Fax: 866-707-3422 | Email: [email protected]

facebook.com/QuantumRehab

youtube.com/QuantumRehab

instagram.com/quantum_rehab

twitter.com/quantumrehab

http://www.quantumrehab.com/resources/downloadorderforms.php?f=electronics/us_alternative_controls_order_form.pdf


https://www.facebook.com/QuantumRehab

https://www.youtube.com/user/QuantumRehab

https://www.instagram.com/quantum_rehab/

https://twitter.com/quantumrehab

Option Name MSRP Part Number Manufacturer Extended Description

Synergy Back $275 SETASMB6463 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,17"H,W/CUSHION,(16"W X 14"H BACK)

SETASMB6639 SEAT BACK,ASSY,SYNERGY STANDARD BACK,16"W,18"H,W/CUSHION,(16"W X 14"H BACK)









SETASMB6640 SEAT BACK,ASSY,SYNERGY STANDARD BACK,17"W,18''D,W/CUSHION,(17"W X 14"H BACK)


















Section NameQuantum 1450 Cross Reference Spreadsheet - TRU-Balance Bariatric Power Tilt

TRU-BALANCE BARIATRIC POWER TILT: Back Cushion Configuration

Page 1 of 5

Option Name MSRP Part Number Manufacturer Extended DescriptionSection Name

Quantum 1450 Cross Reference Spreadsheet - TRU-Balance Bariatric Power Tilt





























Page 2 of 5































Page 3 of 5


























SETASMB6487 SEAT BACK,ASSY,SYNERGY STANDARD BACK,29''W,19"H,W/CUSHION,(29"W X 16"H BACK)





Page 4 of 5


























Page 5 of 5

quantum 1450 with tru-balance bariatric power tilt order form · 4.1b. expandable controls -...

Documents