Pride Mobility Jazzy Passport Owner's manual

Brand: Pride Mobility

Model: Jazzy Passport

Type: Owner's manual

Page 1 of 2INFINFB4214/RevA/01OCT2020

Jazzy

Passport — Quick-Ship Order Form

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 in Adobe Acrobat Reader and may not function correctly if opened with applications other than Acrobat.

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, specications, part numbers, and availability are subject to change without notice. Prices and part numbers as shown are only available

when congured as a complete power chair. Pride Providers may contact Technical Service for accurate parts ordering.

Thank you for choosing Pride Mobility Products!

Pride

Mobility Products Corporation

401 York Avenue, Duryea, PA 18642

Phone: 1-800-800-8586 | Fax: 1-800-800-1636 | Email: prideorders@pridemobility.com

Jazzy Passport

Par t: FJPTBK1700

HCPCS: K0899 — Power mobility device, not coded by DME PDAC

or does not meet criteria.

Select one option below:

Jazzy Passport (FJPTBK1700) with 18Ah Lithium-ion Battery (BAT1708123) ................................................. TOTAL MSRP $2,899

Jazzy Passport (FJPTBK1700) with 10.4Ah Travel* Lithium-ion Battery (BAT1802153) ................................. TOTAL MSRP $2,859

18Ah Lithium-ion Battery ..................................................$699

Par t: BAT1708123 - P

10.4Ah Travel* Lithium-ion Battery ..................................$649

Par t: BAT18 02153- P

BASE MODEL

REQUIRED. Select a power base. 250 lb. weight capacity. Find more details at pridemobility.com/jazzy-power-chairs/jazzy-passport.

ADDITIONAL BATTERY PACKS

REQUIRED. Select one battery.

Standard Features

• VSI controller

• Mesh cushion

• Mesh cup holder

• Storage bag

*Note: Transport of this item on commercial aircraft is subject to

federal regulations and airline policy. Please consult your airline

prior to your ight to ensure your Jazzy Passport and its lithium-ion

batteries are permitted.

XLR USB Charger ................................................................................................................................................................................... $38

Part: ACC1704791

ACCESSORIES

Optional.

FDA Class II Medical Device*

Page 2 of 2INFINFB4214/RevA/01OCT2020

BRANCH PATCHES

Optional.

Air Force Patch ............................... $20

Part: ACC140240

Army Patch ..................................... $20

Part: ACC140241

Coast Guard Patch ........................ $20

Part: ACC140239

Marines Patch ................................. $20

Part: ACC140243

Navy Patch ...................................... $20

Part: ACC140244

Purple Heart Patch ........................ $20

Part: ACC140238

Pride

Mobility Products Corporation

401 York Avenue, Duryea, PA 18642

Phone: 1-800-800-8586 | Fax: 1-800-800-1636 | Email: prideorders@pridemobility.com

NOTES

*Jazzy® Power Chairs are FDA Class II Medical Devices designed to aid individuals with mobility impairments.

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Pride Mobility Jazzy Passport Owner's manual

Brand: Pride Mobility

Model: Jazzy Passport

Type: Owner's manual

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Pride Mobility Jazzy Passport Owner's manual

Pride Mobility Jazzy Passport Owner's manual

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