(A3) | Order Form...Part No. Description Code Retail Hip Support (Mandatory)019-00053-J Standard Hip Support $ 322 019-00029 Soft Padded Hip Strap $ 110 019-00035 Rigid Padded Hip

Part No. Description Code Retail

Headrest

022-00003 Headrest Soft Density / Shapeable Laterals Low Profile (3’’ x 5’’) $ 255

022-00004 Headrest Soft Density “ Shapeable Back Plate” $ 212

022-00002 Headrest Rigid Density “Not Shapeable” $ 212

022-00001 Headrest Soft Density “Not Shapeable” $ 212

022-00005 Multi-angle Adjustable Headrest $ 386

Headrest Mount

020-00004-A Multi-axis Headrest Mount 45° $ 199

020-00001-A Straight Multi-axis Headrest Mount $ 199

020-00005-A Dual-anchorage Multi-axis Headrest Mount $ 255

020-00006-A Flip-back Multi-axis Headrest Mount $ 301

020-00007-A Standard Headrest Mount 90° $ 301

020-00009-A Offset Headrest Mount 90° $ 301

020-00008-A Multi-axis Headrest Mount triple pivot $ 301

Foot Support (Mandatory)

Multi-axis footplate $ NC

Foot Support Accessories

140-00001-TS Toe strap for foot holder (pair) $ 25

140-00001 Foot holder (pair) (Width x Depth) $ 104

Knee Support (Mandatory)

019-00032-J 60º fixed knee support with Padded straps (pair) $ 535

019-00030-J 60º Multi-axis knee support with padded straps (pair) $ 639

Starter Kit : Base Model :

Red Blue Purple

• Base with 4 swivel Casters

• Mast reciever

• Knob adjustment tool

• Hand operated gas spring

• Full upper body planner pad

• Mast

• Multi-Axis foot support

Canada 4.0

(019-00014-JH) (019-00014-JP) (019-00014-JS)

Black

Hybrid $2830 Prone $2620 Supine $2725

A3

3 ½’’ x 6 (4) 4 ½’’ x 7’’ (5) 5 ½’’ x 8’’ (6)

3 ½’’ x 6’’ (4) 4 ½’’ x 7’’ (5) 5 ½’’ x 8’’ (6)

4 ½’’ x 4’’ (14) 5’’ x 4 ½’’ (16) 5 ½’’ x 5’’ (17)

4’’ x 7 1 ¼ ’’ (4) 5’’ x 8’’ (5) 6’’ x 9’’ (6)

4’’ Anchor Distance (4) 9’’ Anchor distance (9)

(A3) | Order Form |

Ord

er F

orm

Company :Quote :

PO Number :Marked for :

Ship to :

Address :City :

State :Zip :

Phone :

5” x 13” (8)

4” x 9 ½” (5) 4 1 /4 ” x 10 ½” (6) 4 ¾” x 12” (7)

A Floor - Head B Floor - Shoulder C Width - ShoulderD Floor - AxillaE Width - Axilla

Required Measurement F Depth - ThoraxG Floor - ElbowH Floor - Mid HipI Width - HipJ Depth - Hip K Floor - Knee

Part No. Description Code Retail

Hip Support (Mandatory)

019-00053-J Standard Hip Support $ 322

019-00029 Soft Padded Hip Strap $ 110

019-00035 Rigid Padded Hip Strap $ 110

019-00036 Swing away hip support $ 423

Upper Body Support

019-00038 Upper body planar pad NC

019-00034-J Standard thoracic Support$ 322

019-00042 Standard thoracic support with elbow stops $ 407

019-00035-35 Padded thoracic Strap $ 110

019-00041 Swing away thoracic support $ 423

Upper Body Accessories

019-00044 Chest harness $ 191

Shoulder (Mandatory on Dorsal & Hybrid)

019-00006 Shoulder support $ 157

Tray

019- Standard tray $ 445

019- Tray with activity bowl tray (5,5 x 11,5 x 2,25) $ 488

019-00046-24 Half Tray padding for tray $ 85

019- Tray with elbow Stop, Mounted on Tray (Pair) $ 467

Other Accessories

019-00002 Push handle (supine & hybrid models) $ 42

019-00051 Cylinder Hand-Lever Lock $ 21

019-00050 Prone Head Support $ 399

019-00052 Hybrid Padded Chinrest $ 212

(A3) | Order Form |

Ord

er F

orm

T.1.888.752.8818 F. 450.752.16441242, De LanaudièreJoliette (Quebec) Canada J6E 3P1

Local : 450 759-9449Toll Free : 866 739-2400

Model S3 Specs• Floor head 45-72 in• Max weight 69kg • Types available - Prone - Supine - Hybrid• Base dimensions 26 x 38 in

A3

Small (s) Medium (m)X-small (xs)

Comments:

(00011-24)

(00049-24)

(00047-24)

(00010-24)

(00057-24)

(00058-24)

Abs (black)Lexan (clear)

Abs (black)Lexan (clear)

Lexan (clear) Abs (black)

| Measurement Guide |

Mea

sure

men

t Gui

de

T.1.888.752.8818 F. 450.752.16441242, De LanaudièreJoliette (Quebec) Canada J6E 3P1

Notes:

11B

10A

9C

8 RIGID PADDED STRAP8) HIP019-00035-35 (3 X 5 Lg)01900035-36 (3 X 6 Lg)019-00035-37 (3 X 7 Lg)019-00035-48 (4 X 8 Lg)019-00035-410 (4 X 10 Lg)019-00035-413 (4 X 13 Lg)

7B) HIP019-00029-35 (3 X 5 Lg)019-00029-36 (3 X 6 Lg)019-00029-37 (3 X 7 Lg)019-00029-48 (4 X 8 Lg)019-00029-410 (4 X 10 Lg)019-00029-413 (4 X 13 Lg)

7 SOFT PADDED STRAP7A) AXILLA019-00028-35 (3 X 5 Lg)019-00028-36 (3 X 6 Lg)019-00028-37 (3 X 7 Lg)019-00028-48 (4 X 8 Lg)019-00028-410 (4 X 10 Lg)019-00028-413 (4 X 13 Lg)

14A) STANDARD(ABS)019-00010-20 (20")019-00010-22 (22")019-00010-24D (24")14B) ACTIVITY BOWL(ABS)019-00057-20 (20")019-00057-22 (22")019-00057-24D (24")14C) ELBOW STOP(ABS)019-00058-20 (20")019-00058-22 (22")019-00058-24D (24")

14 TRAY14A) STANDARD(LEXAN)019-00011-20 (20")019-00011-22 (22")019-00011-24D (24")14B) ACTIVITY BOWL(LEXAN)019-00049-20 (20")019-00049-22 (22")019-00049-24D (24")14C) ELBOW STOP(LEXAN)019-00047-20 (20")019-00047-22 (22")019-00047-24D (24")

SSTTAARRTTEERR KKIITT

MEASURES FOR CUTTING (REF. #LT-0005-E)019-00012 (Anchor block for shoulder & axilla)

019-0001 (Anchor block for hybrid headrest)

020-XXXXX (Headrest mount)

LT-0002-E

synetikergocare.comRevision 2020-01-27

VERTIFLEX A

Page 1 of 2

COMPONENT IDENTIFICATION

[email protected](866) 739-2400

7912

4

5

8

3

12

6

13

11

10

20

22

14

17

15

7

5C

6 ASSEMBLED BASE

019-00003-J (JUNIOR)019-00003-K (KID)019-00003-B (BABY)

6

5 MAST KIT

5B

5A) HYBRID019-00017-B (BABY)019-00017-K (KID)019-00017-J (JUNIOR)5B) PRONE019-00018-B (BABY)019-00018-K (KID)019-00018-J (JUNIOR)5C) SUPINE019-00019-B (BABY)019-00019-K (KID)019-00019-J (JUNIOR)

11 KNEE SUPPORT


11A) STANDARD019-00032-B (BABY)019-00032-K (KID)019-00032J (JUNIOR)11B) MULTI-AXIS

11A

10 HIP SUPPORT10A) STANDARD019-00053-BK3 (4 X 3 Lg)019-00053-BK4 (4 X 4 Lg)019-00053-BK5 (4 X 5 Lg)019-00053-BK6 (4 X 6 Lg)019-00053-BK7 (4 X 7 Lg)019-00053-J05 (5 X 5 Lg)019-00053-J06 (5 X 6 Lg)019-00053-J07 (5 X 7 Lg)019-00053-J08 (5 X 8 Lg)019-00053-J09 (5 X 9 Lg)019-00053-J10 (5 X 10 Lg)10B) SWING AWAY019-00036-BK04 (4 X 4 Lg)019-00036-BK05 (4 X 5 Lg)019-00036-BK06 (4 X 6 Lg)019-00036-BK07 (4 X 7 Lg)019-00036-J05 (5 X 5 Lg)019-00036-J06 (5 X 6 Lg)019-00036-J07 (5 X 7 Lg)019-00036-J08 (5 X 8 Lg)019-00036-J09 (5 X 9 Lg)019-00036-J10 (5 X 10 Lg)

3 SHOULDER SUPPORT

019-00006-412 (4 X 12 Lg)

019-00006-520 (5 X 20 Lg)019-00006-516 (5 X 16 Lg)

(HYBRID & SUPINE MODELS)019-00006-38 (3 X 8 Lg)019-00006-310 (3 X 10 Lg)

3

7

14B

9A

8

13 HALF TRAY PADDING

019-00046-24 (24")019-00046-22 (22")019-00046-20 (20")13

12

9 AXILLA SUPPORT9A) STANDARD019-00034-BK03 (4 X 3 Lg)019-00034-BK04 (4 X 4 Lg)019-00034-BK05 (4 X 5 Lg)019-00034-BK06 (4 X 6 Lg)019-00034-BK07 (4 x 7 Lg)019-00034-J05 (5 X 5 Lg)019-00034-J06 (5 X 6 Lg)019-00034-J07 (5 X 7 Lg)019-00034-J08 (5 X 8 Lg)019-00034-J09 (5 X 9 Lg)019-00034-J10 (5 X 10 Lg)9B) SWING AWAY019-00041-BK04 (4 X 4 Lg)019-00041-BK05 (4 X 5 Lg)019-00041-BK06 (4 X 6 Lg)019-00041-BK07 (4 X 7 Lg)019-00041-J05 (5 X 5 Lg)019-00041-J06 (5 X 6 Lg)019-00041-J07 (5 X 7 Lg)019-00041-J08 (5 X 8 Lg)019-00041-J09 (5 X 9 Lg)019-00041-J10 (5 X 10 Lg)9C) ELBOW STOP019-00042-BK03 (4 X 3 Lg)019-00042-BK04 (4 X 4 Lg)019-00042-BK05 (4 X 5 Lg)019-00042-BK06 (4 X 6 Lg)019-00042-BK07 (4 x 7 Lg)019-00042-J05 (5 X 5 Lg)019-00042-J06 (5 X 6 Lg)019-00042-J07 (5 X 7 Lg)019-00042-J08 (5 X 8 Lg)019-00042-J09 (5 X 9 Lg)019-00042-J10 (5 X 10 Lg)

12 60º LEGS SYSTEM019-00009-B (BABY)019-00009-K (KID)019-00009-J (JUNIOR)

14A

17 PLANAR PAD

019-00038-1322 (13 X 22 Lg)019-00038-1318 (13 X 18 Lg)019-00038-1020 (10L X 20 Lg)

019-00038-56 (5L X 6 Lg)019-00038-510 (5L X 10 Lg)019-00038-68 (6L X 8 Lg)019-00038-612 (6L X 12 Lg)019-00038-710 (7L X 10 Lg)019-00038-714 (7L X 14 Lg)019-00038-812 (8 X 12 Lg)019-00038-816 (8 X 16 Lg)019-00038-1016 (10L X 16 Lg)

17

16 PADDED CHINREST019-0005216

1 HEADREST

022-000031E) SHAPEABLE LATERALS022-00005-17 (5-1/2" H)

1A) RIGID022-00002-4 (4" H)022-00002-5 (5" H)022-00002-6 (6" H)1B) SOFT022-00001-4 (4" H)022-00001-5 (5" H)022-00001-6 (6" H)1C) SOFT & SHAPEABLE022-00004-4 (4" H)022-00004-5 (5" H)022-00004-6 (6" H)1D) MULTI-ANGLE ADJUSTABLE022-00005-14 (4-1/2" H)022-00005-16 (5" H)

1A

20 FOOT HOLDER

140-00001-8 (5 x 13 Lg)140-00001-7 (4-3/4 X 12 Lg)140-00001-6 ( 4-1/4 X 10-1/2 Lg)

140-00001-1 (2-1/2 X 5 1/2 Lg)140-00001-2 (3 X 6-3/4 Lg)140-00001-3 (3-1/2 X 7-1/2 Lg)140-00001-4 (3-3/4 X 8-1/2 Lg)140-00001-5 (4 X 9 Lg)

20

14C

22 ABDUCTION SUPPORT


22

15 PUSH HANDLE

019-00002(HYBRID & SUPINE MODELS)15

9B

1C

21 TOE STRAP

140-00001-8TS (FOOT HOLDER #140-00001-8)140-00001-7TS (FOOT HOLDER #140-00001-7)140-00001-6TS (FOOT HOLDER #140-00001-6)

(FOOT HOLDER EXCLUDED)140-00001-1TS (FOOT HOLDER #140-00001-1)140-00001-2TS (FOOT HOLDER #140-00001-2)140-00001-3TS (FOOT HOLDER #140-00001-3)140-00001-4TS (FOOT HOLDER #140-00001-4)140-00001-5TS (FOOT HOLDER #140-00001-5)21

19 CHEST HARNESS

019-00044-L (LARGE)019-00044-M (MEDIUM)019-00044-S (SMALL)

19

1B

9B

18 PRONE BACKSLING


18

10B

2B

2F

2E

2 HEADREST MOUNT

2A2A) 020-00004 (45º MULTI-AXIS)2B) 020-00001 (STRAIGHT MULTI-AXIS)2C) 020-00005-4 (4" DUAL ANCHORAGE MULTI-AXIS)2D) 020-00005-9 (9" DUAL ANCHORAGE MULTI-AXIS)2E) 020-00006 (FLIP BACK MULTI-AXIS)2F) 020-00007 (90º STANDARD)2G) 020-00008 (MULTI-AXIS)2H) 020-00009 (OFFSET)

2C

2D

2H

5A

2G

1D

1E

4B

4 SUPPORT RECEIVER

019-00007-JS (JUNIOR)019-00007-KS (KID)019-00007-BS (BABY)

4A) STANDARD AXILLA019-00007-B (BABY)019-00007-K (KID)019-00007-J (JUNIOR)4A) STANDARD HIP019-00020-B (BABY)019-00020-K (KID)019-00020-J (JUNIOR)4B) SMALL AXILLA

4A

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Documents

(A3) | Order Form...Part No. Description Code Retail Hip Support (Mandatory)019-00053-J Standard Hip Support $ 322 019-00029 Soft Padded Hip Strap $ 110 019-00035 Rigid Padded Hip