Pride Mobility Jazzy 614 HD Quick Ship Owner's manual

Page 1 of 4INFINFB3704/RevG/03FEB2020

Jazzy 614HD

Quick Ship Order Form

Account Number: ___________ Date: ________________

Provider Name: __________________________________

Contact: ________________________________________

Phone: ___________________ Fax: _________________

Email: __________________________________________

PO Number: _____________________________________

Marked for: _____________________________________

Ship to Address: _________________________________

City: _____________________ State: ______ Zip: ______

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 Services for accurate parts ordering.

Thank you for choosing Pride Mobility Products!

INTRODUCTION

Candy Apple Red

Part: SHDASMB5335

Viper Blue

Part: SHDASMB5336

BASE COLOR

REQUIRED. Select one color. Colors shown here may dier from actual product depending on monitor/printer calibration.

Jazzy 614HD 2HD-C ........................................................ $5,299

Part: J614HD 2HD-C. HCPCS: K0825

Captain Seating

Jazzy 614HD 2HD-SS...................................................... $5,299

Part: J614HD 2HD-SS. HCPCS: K0824

Solid Seat Pan Seating

Standard Features

• Mid-wheel drive technology

• Active Trac

suspension

• 14″ drive tires

• In-line joystick

• 5-amp o-board charger

• Height-, angle-, and depth-adjustable foot platform

BASE MODEL

REQUIRED. Select a power base. Weight capacity: 450 lbs. Find more details and specications at pridemobility.com/jazzy-614-hd.

Pride

Mobility Products Corporation

182 Susquehanna Ave., Exeter, PA 18643

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

614 HD

NF-22, 50-amp .................................................................................................................................................................................$330 ea.

Part: BATLIQ1018. HCPCS: E2361

BATTERIES

REQUIRED. The power chair requires two batteries. The batteries are automatically selected with a Quick Ship order.

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Account Number: ___________ Date: ________________ Marked for: _____________________________________

Swing-Away Leg Rests with 7.25″ × 6″ Foot Plates (pair) ..$162

Part: RIG133656

Swing-Away Leg Rests with 8.5″ × 6″ Foot Plates (pair) ..$162

Part: RIG133659

Elevating Leg Rests with 7.25″ × 6″ Foot Plates (pair) ..... $325

Part: KIT124479. HCPCS: K0195

Elevating Leg Rests with 8.5″ × 6″ Foot Plates (pair) .... $325

Part: KIT124480. HCPCS: K0195

LEGRESTS

Optional. Some adjustments may be needed upon receipt of the unit.

60° – 90° Swing-Away Leg Rests

Adjustable in 5° increments.

Elevating Leg Rests

Leg Rest Accessories

Residual Limb Support ......................................... $325 ea.

Left part: FRMASMB5301. Right part: FRMASMB5300

HCPCS: E1020

Heel Loops (pair) .................................................................. $50

ELR part: FRMASMB1503. S/A part: FRMASMB7873

HCPCS: E0951

ARMRESTS

REQUIRED. The armrests are automatically selected with a Quick Ship order.

* 1 6″ W × 1 6 ″ D .................................. $450

Part: SETASMB3178

With 60″ Lap Belt

* 1 6″ W × 1 8 ″ D .................................. $450

Part: SETASMB3179

With 60″ Lap Belt

1 8″ W × 1 8″ D ........................... Standard

Part: SETASMB2848

With 60″ Lap Belt

1 8″ W × 2 0″ D ........................... Standard

Part: SETASMB3182

With 60″ Lap Belt

* 2 0″ W × 18 ″ D .......................... Standard

Part: SETASMB3184

With 60″ Lap Belt

* 2 0″ W × 2 0″ D .......................... Standard

Part: SETASMB3185

With 60″ Lap Belt

Deluxe Contour, Limited Recline, High Back with Solid Seat Pan

Additional lead time may apply.*

Flip-up, Height-Adjustable, Full-Length Armrests .................................................................................................................$85 ea.

Left part: FRMASMB8614. Right part: FRMASMB8615

HCPCS: E0973

Solid Seat Pan Seating

1 8″ W × 1 8″ – 2 0 ″ D ................... Standard

Part: SETASMB6895

With 60″ Lap Belt

2 0 ″ W × 1 8″ – 2 0″ D ................... Standard

Part: SETASMB6896

With 60″ Lap Belt

2 2 ″ W × 2 0 ″ – 2 2″ D .................. Standard

Part: SETASMB6897

With 70″ Lap Belt

Depth-Adjustable, Fold Flat, Limited Recline, High Back

1 8 ″ W × 1 6″ D ............................................................................................................................................................................................ $450

Part: SETASMB2775

With 60″ Lap Belt

Deluxe Contour, Limited Recline, High Back

Additional lead time may apply.

2 2 ″ W × 1 8″ D ...................................$450

Part: SETASMB2171

With 70″ Lap Belt

* 2 4″ W × 2 0″ D .................................. $450

Part: SETASMB2387

With 80″ Lap Belt

2 4 ″ W × 2 2″ D ................................ $1,000

Part: SETASMB2388

With 80″ Lap Belt

Deluxe Contour, High Back

Additional lead time may apply.*

Captain Seating

SEATING

REQUIRED. Select one seat size. Seats come with a lap belt. Maximum weight capacity is 400 lbs. when seat is set at 18″D.

Page 3 of 4INFINFB3704/RevG/03FEB2020

Account Number: ___________ Date: ________________ Marked for: _____________________________________

Swing-Away, In-line ..................................................... $245

Left part: ACC148368. Right part: ACC148369

HCPCS: E1028

Swing-Away, 1″ Oset ................................................. $245

Left part: ACC148370. Right part: ACC148371

HCPCS: E1028

JOYSTICK MOUNTING BRACKETS

Optional. The power chair comes standard with an in-line joystick mounting bracket. Additional brackets may be selected below.

Swing-Away Joystick

In-line Mount (Right)

Swing-Away Joystick

Offset Mount (Right)

50″ Lap Belt ............................... $39.90

Part: ACCBELT1000

60″ Lap Belt ............................... $39.90

Part: ACCBELT1002

70″ Lap Belt ................................ $39.90

Part: ACCBELT1003

80″ Lap Belt ............................... $39.90

Part: ACCBELT1004

90″ Lap Belt ............................... $39.90

Part: ACCBELT1001

Additional Lap Belts

Optional. Seats come standard with a lap belt. An additional lap belt may be selected below.

Rear Basket (15.25″ × 9.75″ × 9.5″) ......................................$118

Part: ACCASMB1914

Cane/Crutch Holder ............................................................ $110

Part: ACCASMB2294. HCPCS: E2207

Oxygen Tank Holder ........................................................... $118

Part: ACCASMB2292. HCPCS: E2208

Walker Holder ......................................................................$103

Part: ACCASMB1912

Back-Mounted Accessories

Optional. Only one back-mounted accessory can be used at a time. Includes mounting bracket and hardware.

Cup Holder — Style B ..................... $20

Part: ACCASMB2287

Weather Cover, Large, Black ...... $202

Part: ACCCOVR1021

Flag Holder ..................................... $25

Part: ACCASMB1930

Saddle Bag (12.5″ × 9.875″) ............ $35

Part: DWR1020D010

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

Part: ACC1704791

Bell-Shaped Foot Platform ......... $235

Part: RIGASMB7120041

Dynamic DX Programmer ........... $423

Part: ELEASMB4352

With Flight adapter

ACCESSORIES

Optional.

Special Measurement Seat

SPECIAL MEASUREMENT SEAT

Optional. Special measurement seats are not available as a Quick Ship order. Seat size cannot exceed 24″W × 24″D. Contact your inside sales

specialist for pricing.

Width:______ Depth:______

Seat Type:_______________

Match seat width and depth — see cushion order form or

cushion part number:

Non-matching cushion size — see cushion order form or

cushion part number:

CUSHION QUICK PICK

Optional. Refer to the specic cushion order form for pricing, sizes, codes, and part numbers. If the cushion size matches the selected seat size,

check Match seat width and depth. If the cushion size diers from the seat size, check Non-matching cushion size. Attach the cushion order

form, or ll in the cushion part number below.

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

Page 4 of 4INFINFB3704/RevG/03FEB2020

NOTES

Pride

Mobility Products Corporation

182 Susquehanna Ave., Exeter, PA 18643

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

youtube.com/

pridemobility

facebook.com/

PrideMobilityProductsCorp

twitter.com/

pridemobility

instagram.com/

PrideMobilityProducts

Account Number: ___________ Date: ________________ Marked for: _____________________________________

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

REFERENCE ORDER FORMS

Optional. Select below to note that additional order forms will accompany this order form.

See cushion order form

Synergy Seat (Not a Quick Ship option)

Pride Mobility Jazzy 614 HD Quick Ship Owner's manual

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