Categories: Clinical Forms : Prescription Blanks
70110189_170110262 Ca Rx Standard 0120 update_Dental

California Prescription Blanks – 1 User, 2 Part, Personalized, 5-1/2" W x 4-1/4" H, 100 Sets/Pad, 10 Pads/Pkg

Patterson Office Supplies
Patterson Item #: 011-0262
Mfg Item #: VJO-PTC9-PAT3
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Specifications

# of Parts:
2 part
Design Color:
Blue
Dimensions:
5-1/2" W x 4-1/4" H
Ink Color:
Black
Logo:
N
Manufacturer Name:
PATTERSON OFFICE SUPPLIES
Material:
Two-Part carbonless stock; First Part – 26 lb white CB Security Paper with reflex blue, thermochromatic magenta and black ink on face and security ink on back. Second Part – 20 lb blank canary CF
Package Quantity:
100 Sets/Pad; 10 Pads/Pkg
Product Color:
White/Yellow
Security Features:
Security paper with the security features listed on the back of each blank
  • Chemical void feature: “Void” appears when blank or completed form is photocopied
  • Thermo-chromatic ink reaction
  • Micro print signature line
  • Quantity check-off boxes
  • Opaque Rx in top right corner (on single prescription blanks)
  • Sequential numbering and unique batch number
  • The “California Security Prescription” watermark is printed on the back of each blank.
  • CA requires an adult signature at time of delivery for all prescription blank orders. An additional fee may apply.
State Requirements:
Meets

Legend

Promotion
Auto Free Good
My Catalog
My Catalog (Rep)
On Formulary
On Contract
Prescription
Hazmat-Chargeable
Hazmat-No Charge
MSDS / SDS
Schedule 2 and 2N
Schedule 3, 3N, 4 and 5
List 1
No Freeze
Prices in Green indicate discounted price.