Tech Pak Qualification Worksheet

Rosie Vital Signs Carts can be acquired through purchase, lease or our Tech Pak program, which allows your facility to qualify for carts with no impact to the capital budget.

Would you like to know how many Rosie Vital Signs Carts we can place in your facility with the Tech Pak Program? Please complete the following form for each product that you use in your facility. As products are packaged differently, please be accurate with box or case counts. Please indicate your average usage per month.

One of our associates will contact you within 2 business days to explain how many Rosie carts you qualify for!

Items marked with an asterisk (*) are required.

Facility Name:*

Contact Name:*

Contact Phone Number:*

Contact Email:*

ItemNumber of Cases/Boxes per MonthNumber of Items per Case/Box Cost per Case/Box
Glucose Test Strips
Safety Lancets
Insulin Syringe 1cc
Insulin Syringe
cc
TB Syringe
Incontinence Wet Wipes (9x13)
Wipes Per Case:
Thermometer Probe Cover
Nasal Cannulas
Alcohol Prep Pads
Pump Spike Sets
Gravity Bag Sets
Pump Bag Sets
Moisture Barrier (4oz tubes)
Anti-Fungal Cream (4oz tubes)
Wound Cleanser (8oz bottles)
Hydrogel Dressing (3oz tubes)
Wound Gel (3oz tubes)
Silver Med Gel (3oz tubes)
Bordered 4x4 overall; 2x2 pad
Bordered 6x6 overall; 4x4 pad
Bordered 6x8 overall; 4x6 pad



Items marked with an asterisk (*) are required.