Cart Quote Form Name * Email * Phone Number * Facility Name Address Zip/Postal Code Preferred method of contact Email Phone Please fill in the following information to receive a quote Choose one 0-10 11-20 21-30 31-40 41-50 51-60 61-72 How many patients do you need medication storage for in total? How many wings are these patients spread out across? Would you like for your cart to have the ergonomic height adjustable option Yes No What medication system are you currently using? Card and blister/ Punchcard systems / Bingo Cards (Pharmafile or Pharmabins) Multidose Strip Packages ((pouch Porters, diamond dispensers, pouch porter trays) Tear apart card / multidose cards (Dispill Rack) Vials Other If ‘other’ please specify How are your narcotics prepared? Card and blister system Controlled drug pack Strip packaging Other If ‘Other’ please specify How does your facility chart medications? Tablet Manual charting Monitor Laptop Other If ‘other’ please specify What do your nurses bring on a med pass (Select all that apply) Gloves Sharps containers Med cups Juice Food transport items for crushed meds CPS Drug compendium Chart binders Drinking cups Ointments eye drops creams Hand sanitizer Treatments, bandages, gauze, syringes, wipes. etc. Does your facility crush meds? Yes No If yes, how many patients require crushed meds? Get a quote
