Washington State Medicaid Order Forms

(Dated Prior to 1-5-15)

Power Chairs (WA Only)

J6 Series SP (WA Only)
J6 Series Standard (WA Only)
Jazzy 1450 SP (WA Only)
Jazzy 1650 Series (WA Only)
Jazzy 614 (WA Only)
Jazzy 614 HD (WA Only)
Jazzy Select 14 (WA Only)
Jazzy Select Elite (WA Only)
Jazzy Select HD (WA Only)
Quantum 1420 SP/MP (WA Only)
Quantum 1450 SP (WA Only)
Quantum 1450 SP MP (WA Only)
Quantum 600 SP/MP (WA Only)
Quantum 610 SP (WA Only)
Z-Chair (WA Only)

Seating and Positioning (WA Only)

Solid Seat Insert (WA Only)
Specialty Seat Kit (WA Only)
Tru-Balance 2 (WA Only)

Electronics (WA Only)

Q-Logic Controls (WA Only)

Manual Wheelchairs (WA Only)

LiteStream Junior (WA Only)
Litestream XF (WA Only)
Stylus LS (WA Only)

Go-Go Travel Mobility (WA Only)

Pride Lifts (WA Only)

About Quantum Rehab

Quantum Rehab® was born out of the desire to delight customers with the most advanced, consumer-inspired complex rehab power wheelchairs and related technologies possible.

At Quantum, consumer needs and wishes are the driving force. We’re dedicated to not just meeting medical and clinical needs, but also quality-of-life needs. From the most advanced power seating for pressure management to USB ports, Bluetooth and fender lights, no consumer need is overlooked.

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Quantum Rehab
401 York Avenue
Duryea, PA 18642

1-833-QiLevel (745-3835)

Monday - Friday
8:30am - 5:00pm ET