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Quantum Rehab Q6 Edge 2.0 Manual

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Quantum
401 York Ave., Duryea, PA 18642
Phone: 866-800-2002 | Fax: 866-707-3422 | Email: quantumorders@pridemobility.com
Q6 Edge
2.0 Order Form with Pediatric TRU-Balance
®
Account Number: ___________ Date: ________________
Provider Name: __________________________________
Contact: ________________________________________
Phone: ___________________ Fax: _________________
Email: __________________________________________
PO Number: _____________________________________
Marked for: _____________________________________
Ship to Address: _________________________________
City: _____________________ State: ______ Zip: ______
INTRODUCTION
This form is interactive when viewed with
tions other than Acrobat.
Complete 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 (quantumorders@pridemobility.com).
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
HCPCS codes provided should not be considered as legal advice and do not guarantee reimbursement. DME providers
are responsible for determining 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
PATIENT INFORMATION
Weight:________ Height:________
INFINFB3537/RevF/05OCT2017
Rehab
®
Adobe Acrobat Reader
with this order form.
Thank you for choosing Quantum!
A. Shoulder Width: _______
B. Chest Width: _________
C. Hip Width: ___________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
and may not function correctly if opened with applica-
cross-reference spreadsheet
D. Max Sitting Height: ____
E. Shoulder Height: ______
F. Axilla Height: _________
3 Positioning
®
for the XRef part numbers.
G. Thigh Depth: _________
H. Lower Leg Length: ____
I. Elbow Height: ________
Page 1 of 18

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Summary of Contents for Quantum Rehab Q6 Edge 2.0

  • Page 1 Quantum Rehab ® 401 York Ave., Duryea, PA 18642 Phone: 866-800-2002 | Fax: 866-707-3422 | Email: quantumorders@pridemobility.com Q6 Edge 2.0 Order Form with Pediatric TRU-Balance 3 Positioning ® ® Account Number: ___________ Date: ________________ Provider Name: __________________________________ Contact: ________________________________________ Phone: ___________________ Fax: _________________ Email: __________________________________________ PO Number: _____________________________________ Marked for: _____________________________________...
  • Page 2: Drive Motors

    Select a power base. 300 lb. weight capacity with standard 6mph programmable motors and 8 amp off board charger. Dimensions of base without legrests: 24”Wx35.5”L Quantum Q6 Edge 2.0 3S-SS ......... $7,595 Quantum Q6 Edge 2.0 3MP-SS ......$7,595 Part: Q6 EDGE 2.0 3S-SS. HCPCS: K0848 Part: Q6 EDGE 2.0 3MP-SS.
  • Page 3 Account Number: ___________ Date: ________________ Marked for: _____________________________________ DRIVE WHEELS continued Rim Color Rim colors other than the standard are available through a special order and extended lead time. Standard Rims ..........Standard Match Rims to Base Color ........$85 Standard item does not print on quote acknowledgment. No Part: SOF Non-matching Rims ..........$85 No Part: SOF - Select color below...
  • Page 4 Account Number: ___________ Date: ________________ Marked for: _____________________________________ ELECTRONICS continued Q-Logic 3 Joystick Shroud REQUIRED with Q-Logic 3 EX Joystick selection above. Reference colors shown on page 2. Black, Soft Touch ........... Standard Match Joystick Shroud to Base Color ......$50 Part: DGN124307 Part: PTOINDV3421 Non-matching Joystick Shroud .........$50...
  • Page 5 Account Number: ___________ Date: ________________ Marked for: _____________________________________ JOYSTICK MOUNTING BRACKETS continued Specialty Joystick Mounts Select a bracket and side to mount it. Retract4 Mount ........$350 Stealth Swing-Away/Flip Down Bracket ..$294.25 NE/NE+ Part: MEC138876. HCPCS: E1028 SAJ Part: ST-TWBM480CJ-Q. HCPCS: E1028 Retract4 Q-Logic Part: MEC138860.
  • Page 6: Transit Kit

    ® Transit Kit Optional. The Q6 Edge 2.0 is standard with Unoccupied Transit Loops. 60” Sure-Lok Lap Belt is required with Occupied Transit Option. WC-19 Occupied Transit Option....... $275 To determine if your chair is WC-19 compliant (occupied), please re- fer to this website: http://wc-transportation-safety.umtri.umich.edu/...
  • Page 7 Account Number: ___________ Date: ________________ Marked for: _____________________________________ TRU-BALANCE 3 SEATING continued Back Cushion Configuration REQUIRED except when back cane option selected. Select a configuration type and applicable dimensions. See the Sport, Q-Back, and TRU-Com- fort 2 back availability chart for stock order back size ranges. Other size backs may be available with Special Order and extended lead time. Sport Back..........
  • Page 8 Account Number: ___________ Date: ________________ Marked for: _____________________________________ ARMRESTS REQUIRED. Select the desired type of armrest below. Please read notes to ensure seating compatibility. Be sure to also select an armrest size and armpad type. Armrests are order in pairs but shown as left and right for configuration purposes. TRU-Balance 3 Flip-Back Armrests Choose a left and right TRU-Balance 3 armrest and set height in the following section.
  • Page 9 Account Number: ___________ Date: ________________ Marked for: _____________________________________ JOYSTICK BRACKET RECEIVER REQUIRED. Standard Fixed Receiver ........Standard Part: ACC123525 Stealth Height Adjustable Receiver ......$214 Tube Arm Part: ST-ARM250C-Q. HCPCS: K0108 Height Adjustable Height Adjustable Track Arm Part: ST-ARM250T-Q. HCPCS: K0108 Receiver (Tube Arm) Receiver (Track Arm) HEADRESTS...
  • Page 10: Attendant Control

    Account Number: ___________ Date: ________________ Marked for: _____________________________________ POWER LEGREST CONTROL Optional. Specific power legrest options are selected later in this form. Select the control type here, if power legrests are desired, to assist the selection of the power positioning electronics. Independent Legrests (Requires 2 actuator controls) Articulating Foot Platform (Requires 1 Actuator Control) Part: Configuration selection...
  • Page 11 Account Number: ___________ Date: ________________ Marked for: _____________________________________ LEGRESTS Optional. All efforts will be made to accommodate legrest length selection, but minor changes may need to be made to meet shipping guide- lines. Some adjustments may be needed upon receipt of the unit. Reference the section’s compatibility matrix for legrest interference. Center Mount Foot Platforms If power articulating foot platform is selected, be sure power legrest control has been selected in previous section.
  • Page 12: Elevating Legrests

    Account Number: ___________ Date: ________________ Marked for: _____________________________________ LEGRESTS continued 90° Pediatric Swing Away Legrests Only available as a pair. Pediatric Swing Away Legrests with 7"-10" Lower Extensions ..............$81 ea. Pair part: FRMASMB8808. Left: FRMASMB8809. Right: FRMASMB8810. Select footplates Angle Adjustable Footplate(s) with Heel Loops 4”Wx6”D ..........$85 ea.
  • Page 13 Account Number: ___________ Date: ________________ Marked for: _____________________________________ LEGRESTS continued Elevating Legrest Accessories Heel Loops (pair) ..........$50 Wheel Bumper ..........$12.50 ea. Part: FRMASMB7873. HCPCS: E0951 Part: See XRef. Standard on angle adjustable footplates. Available on Angle Adjustable Footplates. Falcon Gel Padded Knee Adductor Buttons (KBE) (pair) ..$125 Part: INDPART2242.
  • Page 14: Battery Installation

    Account Number: ___________ Date: ________________ Marked for: _____________________________________ PROVIDER INSTALLED ACCESSORIES Optional. Multiple accessories can be mounted along the various tracks but some interference may occur. TRU-Balance 3 Cup Holder ....No Charge Large, Black, Weather Cover ....$168 Part: ACC125003 Part: ACCCOVR1021 For use with TRU-Balance 3 (track style) armrests.
  • Page 15 Account Number: ___________ Date: ________________ Marked for: _____________________________________ MANUFACTURER INSTALLED POSITIONING COMPONENTS Optional. More options are available on the Positioning Components Order Form. Stealth Thoracic Laterals Swing-away laterals may interfere with TB3 and 2-post, flip up armrests. These laterals are not available with the back cane option. Bracket Swing-away, Rail Mounts, pair (TWBTLTC) .....$472.50 Part: INDPART2677.
  • Page 16 Account Number: ___________ Date: ________________ Marked for: _____________________________________ NON-INSTALLED POSITIONING COMPONENTS Optional. More options are available on the Positioning Components Order Form. Stealth Foot Boxes Stealth Small Foot Boxes, 5"Wx8"Dx7"H ....$498.75 Stealth Large Foot Boxes, 7"Wx12"Dx11"H ..... $498.75 (SPLE107) (pair) (SPLE109) (pair) Part: INDPART2786.
  • Page 17: Specialty Controls

    Account Number: ___________ Date: ________________ Marked for: _____________________________________ SPECIALTY CONTROLS Optional. Select a type of specialty controls below or to refer to the specialty controls order form. Enhanced Display Q-Logic 3 Enhanced Display Kit ................... $1,720 Part: CTL167726 Select a color option below. Includes enhanced display, flexible gooseneck and mounting bracket. Features: 3.5” LCD display;...
  • Page 18 Positioning Components Order Form Quantum Rehab ® 401 York Ave., Duryea, PA 18642 Phone: 866-800-2002 | Fax: 866-707-3422 | Email: quantumorders@pridemobility.com ©2017 Quantum Rehab - A Pride Mobility Products Corporation company. All rights reserved. youtube.com/ facebook.com/ twitter.com/ instagram.com/ QuantumRehab QuantumRehab...