Quantum®Q6 Edge HDMASS 2014August 2015204 kg weight capacity

State: P/C:

Account Number: Provider Name: Contact: Phone: Fax: Email: Date: PO#: Marked For:

Ship To: Address: City: Discount:Terms:Freight:Taken By:

SPECIFIED DIMENSIONS*

Quantum Rehab®A Division of Pride Mobility Products Australia®

20-24 Apollo Drive, Hallam, Victoria Phone: (03) 8770 9600 Fax: (03) 9703 2960

Revised: August 2015 Page 1 of 3

You must supply patient information for optimal setup prior to shipping. Client Weight: Less than 450lbs (204kgs)

A. Seat Width:B. Lateral Offset:C. Hip/Thigh Lateral Offset:D. Center of Gravity: Optimized based on seat dimensionsE. Seat Depth:F. Back Height from Pan:G. Lateral Height from Pan:H. Armrest Height from Pan:I. Rigging Length (whole numbers only):J. Seat to Floor Height (select one):

Seating System Seat-To-Floor HeightsTRU-Balance® Tilt 18.125” 18.187” 20.187”Synergy Seat 16.500” 17.500” 18.500”

Seat to floor height are +/- 1/8” with 18”W x 18”D with solid tires (add 3/8” for pneumatic tires). Increased widths may increase lowest seat to floor heights

Clinician Notes:

Revised: August 2015 Page 2 of 3

Quantum® Q6 EDGE HD Order Form

q Base Mounted Foot Platform

q 8 Amp, Off-board Charger

Description BASE MODEL

COLOURS

Description

BASE MOUNTED FOOT PLATFORM

Description

BATTERY CHARGER

Onyx Black

Quantum Q6 Edge HD

Q-Logic Joystick must be ordered with a Q-Logic Controller and Harness For Expandable Controls

Description

CONTROLLER

q Q-Logic Joystick V2Mount:

RightBack Left Front Left

Description

JOYSTICK MOUNTING BRACKETS

Fixed InlineLeft Right

Swing-AwayLeft Right

Description QUICK DISCONNECT

STANDARD

UPCHARGE

UPCHARGE Quick Disconnect

Description TRU-BALANCE® POWER POSITIONING SYSTEMS

TRU-Balance® HD Power Tilt Weight Capacity of 204 kg (450 lbs)

Q-logic; please select module to be used for tilt.

AAM AM2 Mount under seat (AM2)

SEATING SPECIFICATIONS

Seat Width: q 15” q 16”

q 22”

q 17”

q 23”

q 18”

q 24”

q 14”

q 20” q 21”

Seat Width Package:q 14”W-18”W q 16”W-20”W q 20”W-24”W

Seat Depth: q 15” q 16”

q 22”

q 17”

q 23”

Description SYNERGY SEATING SYSTEM

m Synergy Static Seat

Standard Metallic Colours

Candy Apple Red

Viper Blue

Right

RightBack Left Front Left

Right

q Q-Logic Standalone JoystickMount:

Description

Description

BATTERY

q MK Gel, 70-Amp Batteries (Requires 2 batteries)

Clear Controllers

Clear Colours Clear Joystick Mounting Brackets

q 18”

24”

Clear Seat Specs.

Clear Seat System

q 21”

q 14”

q 20”

q 14”D-18”D q 16”D-20”D q 20”D-24”D 24"D-28"D

q 19”

q

q 19”

**additional $60 build charge applies if depth/width seat packages are not same size** Please tick this box if this applies to your selected seat packages:

JOYSTICK HANDLES

UPCHARGESTANDARDq Standard Knob

q Medium Ball Handle

24"W-28"W

28"

26"

28"Seat Depth Package:

Revised: August 2015 Page 3 of 3

PLSKNCP1008

Description BACK OPTIONS

Back Cane Options:q Omit Push Handles

q Fold Forward Back Cane Bracket(needs std canes also)

Description SYNERGYTM SOLID STANDARD BACK SEATING

***Particular size dimensions may incur a 4 week wait-period

Synergy Standard Back Width: 22" Wide

Back Height:

20" Wide 24" Wide 26" Wide

Description ARMRESTS

8”H-12”H 10”H-14”H

2-post, Flip-back, Height-adjustable, Removable3,4

Single-post, Height-adjustable, Removable5

Quad Release Lever required?

Removable, Single-post, Height Adjustable, Heavy Duty

Right

Description ARMPADS

Straight, Desk Length

Straight, Full Length Left

Left Right Gel, Desk Length, (3.5”x10”)

Left Right

Description HEADRESTS

q No Headrest Required

Stealth™ Headrest

q Comfort plus 10” Headrest CP250

q Comfort plus 8” Headrest CP450Stealth™ Headrest Mountsq Headrest Hardware Feat 1” Ball, TWB480-1q Headrest Straight Mounting Hardware 1” HMO400

q 5” x 6” q 5” x 8” q 4” x 6”

q 6” x 8”8

Description NON-POWERED LEGRESTS

q 60-90o Angle Adjustable Uppers Swing-Away Legrests6 Angle-Adjustable Footplates7

q 6” x 11”8 8” x 11”9

q Heavy Duty Drop-In Legrests6q Angle Adjustable Footplates7

4” x 6”

6” x 8”8

5” x 6”

6” x 11”8

5” x 8”

8” x 11”9

q

Description HIGH MOUNT FOOT PLATFORM (V2)

Highmount Foot Platform Version 2q м4έπм7έ9Ȅǘ q млέπм4έ9Ȅǘ

q 50” Lap Belt q 60” Lap Belt

Description LAP BELT

Standard Back canes

Flip Forward 22" Canes q Omit Push Handles

18” H 20” H 22" H

Cushion: Standard Back cushion included.

Gel, Full Length (3.5”x14”)

Reset Entire Form

Clear Headrests

Clear Armpads

q 17” q 18” q 19” q 20” q 21”q 22” q 23” q 24” q 25”

Back Cane Height: (overall height)

Clear Armrests

Clear Standard Seating

Clear Back Canes

Clear Legrests

Calf Supports: Calf pads (pair) q Small (6”H x 6”W)

Large (8”H x 8”W)

Quantum® Q6 EDGE HD Order Form

Notes:

Please select the leg length from seat pan to footplate: 11" 12" 13" 14" 15"

16" 17" 18" 19"

FOOTNOTES1. Dual Post Flip-Back Armrest interfere with Meso Brackets. Back width cannot be less that 16"W or exceed 22"W.2. Not available with Flip-Back Arms. Pivot point 2.5" above seat pan.3. Interferes with Swing-Away laterals.4. Height adjustable from 9"-13" in 1" increments.5. Height adjustable from 11"-17" in 1/2" increments. 6. Extensions measured from top of seat pan to footplate.7. Standard with Heel Loops. 8. Requires seat width 18" or greater.9. Requires seat width 20" or greater.

STANDARD

STANDARD

UPCHARGE

UPCHARGE

Left Right

28" Wide

q 70” Lap Belt q 80” Lap Belt

q 90” Lap BeltClear Lap Belts