Categories: Clinical Forms : Prescription Blanks : New Jersey Laser Prescription Blanks – Personalized, Health Care Facility, Nurse Practitioner, Optometric, Eyewear, Physician Assistant, Midwife, 4" W x 5-1/2" H (Rx), 8-1/2" W x 11" H (Overall), 1000/Pkg
0199364_NJ_LZ

New Jersey Laser Prescription Blanks – Personalized, Health Care Facility, Nurse Practitioner, Optometric, Eyewear, Physician Assistant, Midwife, 4" W x 5-1/2" H (Rx), 8-1/2" W x 11" H (Overall), 1000/Pkg

TPA Certified Optometirst, Contact Lens – Use this form only
Patterson Office Supplies
Patterson Item #: 70199364
Mfg Item #: VJO-PTC20-PAT3
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Specifications

# of Parts:
1 part
Dimensions:
8-1/2" W x 11" H (overall)
Ink Color:
Black
Logo:
N
Manufacturer Name:
PATTERSON OFFICE SUPPLIES
Material:
20 lb
Package Quantity:
1000/Pkg
Product Color:
White
Security Features:
  • State seal pantograph printed on front and back of each blank
  • Barcode
  • Serial number starting at 0001
  • 2 Part – Both parts printed
  • Formatted and printed per state requirements.
  • State law requires all prescription orders to be faxed or mailed. Call 1-800-637-1140 for an order form.
  • State law requires an adult signature upon delivery of all prescripiton blank orders. An additional charge may apply.
Software Compatiblity:
Eaglesoft and most other softwares

Legend

Promotion
Auto Free Good
My Catalog
My Catalog (Rep)
On Formulary
On Contract
Prescription
Hazmat-Chargeable
Hazmat-No Charge
MSDS / SDS
List 1
No Freeze
Prices in Green indicate discounted price.