Swifty Pushchair - Tendercare Ltd

Page 1 of 3Swifty PushchairAssessment FormTendercare LtdPO Box 3091LittlehamptonBN16 2WFTel 01903 726161Fax 01903 734083Email info@tendercareltd.comSwifty PushchairClient Name_____________________________________________Contact Name___________________________________________Address______________________________________________________________________________________________________Telephone No___________________________________________Fax No________________________________________________E-mail_________________________________________________SWIFTY PUSHCHAIRPlease tick model required:Note: The Swifty Pushchair has been impact tested and is suitable for use as a vehicleseat. It is supplied with the set of 2 Tie Down Transportation Brackets fitted.Swifty — CompleteTH6806Complete Includes:- Foldable Lightweight Chassis withIntegrated Seat Unit, Padded H Belt, Breathable Fire RetardantUpholstery, Adjustable Seat Depth, Multi-Positional back recline. FixedSeat Tilt-in-Space 15°, Height Adjustable Footrest, Flip Up Footrest,Swivelling Front Wheels, Rear Brakes, Height Push Bar, Slot forPommel/Abduction Block with Zip, Set of Tie Down TransportationBrackets fitted.Seat DepthSeat WidthSPECIFICATIONSSpecificationsSwifty220 - 285mm340mmMaximum Carrying Weight of Occupant and all accessories 35kgBack Height620mmACCESSORIESRamped Seat Pad *TH6314(not suitable for use with pommel)Grip Rail TH 6833Frame Padding TH 6622/4Heel Straps - Pair (Cam Buckles) TS 6592Toe Straps - Pair (Cam Buckles) TS 6591Sun Canopy - Umbrella Type TH 6594Raincover - Transparent TH 6638/1Sun/Raincover (Hood & Leg Cover) Black Fabric TH 6637/4Sun/Raincover (Hood Only ) Black Fabric ** TH 6637/61Transparent Rain Shield for Sun/Raincover ** TH 6739** These parts must be ordered together to form a complete raincoverRain Cape - Grey TH 6340Playtray - Transparent TH 6822Shopping Basket (Max carrying capacity 3Kg) TH 6813Sleeping Bag - Woven Fur TH 6618/41” Side Pads (Pair) TH 68341.5” Side Pads (Pair) TH 68362” Side Pads (Pair) TH 68351” Foam Pad for Footboard (covered) TH 66572” Foam Pad for Footboard (covered) TH 66591” Sacral Pad (uncovered - underneath cover) TSS0434Lower Leg Length160 - 330mmHip Angle 90° -115°Foot Angle 90°Measurement footrest (wxd)310 x 180mmSeat Tilt 15°Total (wxhxd)Folded MeasurementsWeightMax Weight CapacityUpholstery Colour610 x 1020 x 980mm610 x 380 x 730mm12.4kg35kgBlack / RedTRUNK SUPPORTSLateral Trunk SupportsLateral Trunk Supportswith Chest Belt(All Dimensions in mm) A BLateral Trunk Supports(Fixed)TH 6634/4130 130Lateral Trunk Supportswith Chest BeltTH 6633220 100

HEADRESTNEOPRENE HARNESS (Flexible)Page 2 of 3SmallTH6385MedTH6585 A 125 190B 210 325C 105 110D 90 190E 55 100F 225 250(All Dimensionsin mm) A B C D EStandard TH6885 265 140 90 60 -Extra Recess TH6886 265 140 90 80 -STANDARD HARNESS (NON Flexible)See above diagram for measurementsExtra Recesswith curvedsidesOccipitalRollTH6888 265 140 85 80 -TH6887 265 130 85 10 40POMMEL SmallTH6616/4MediumTH6617/4A 185 250B 310 335C 150 185D 160 170E 115 105F 177 215(All Dimensions inmm)Pommel (Size 1)TH 6620/4 A B C D100 60 90OTHER HARNESS OPTIONSSeat Waistcoat (Small)TH6631/4Seat Waistcoat (Medium)TH6632/42 Point Padded Hip Belt (front pull) -Small TH84202 Point Padded Hip Belt (front pull) -Med TH8470Groin Adaptation Strap * (Requires H Harnessor 2 point Hip Belt for fitting)1TH62334 Point Padded Hip Belt (front pull) -Small TH84214 Point Padded Hip Belt (front pull) - Med TH8471Soft Groin Harness - Size 1TH6614/4ANKLE CUFFS (Hook & Loop Release) - Ankle Circumference (A) mm18345 Extra Small 140-17018406 Small 170-20018161 Medium 190-23018222 Large 220-29018284 Extra Large 280-330

PATIENT MEASUREMENT RECORDPage 3 of 3Name: ___________________________________ D.O.B: ________________________Diagnosis: ______________________________________________________________Current Equipment: _______________________________________________________Height: ______________________ Weight: ____________________ M / FDate Measurements Taken: ________________By Whom: ____________________________Please state actual client measurements in mm.1 Top of head to seat: ________2 Top of shoulder to seat: ________3 Under armpit to seat: ________(Axilla Height)4 Actual sitting depth: ________5 Shoulder width: ________6 Chest Width: ________(Arm Pit to Arm Pit)7 Hip width: ________8 Left leg drop: ________9 Right leg drop: ________Any Additional Information / Sketches: