Categories: Clinical Forms : Prescription Blanks
070292789_1D

Washington State Prescription Blanks – 1-Part, Personalized, 5-1/2" W x 4-1/4" H, 100 Sheets/Pad, 10 Pads/Pkg

Patterson Office Supplies
Patterson Item #: 70292789
Mfg Item #: VJO-PTC15-PAT3
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Specifications

# of Parts:
1 part
Design Color:
Gray
Dimensions:
5-1/2" W x 4-1/4" H
Ink Color:
Black
Logo:
N
Manufacturer Name:
PATTERSON OFFICE SUPPLIES
Material:
24 lb Security Paper
Package Quantity:
100 Sheets/Pad; 10 Pads/Pkg
Product Color:
White
Security Features:
  • The State of Washington requires the state seal be printed on every prescription form. Also built into the seal is an image of a mortar and pestle, which is printed as a gray watermark
Security features listed on face:
  • 2 signature lines – one for "Dispense as written" and one for "Substitution permitted"
  • Quantity check off boxes (optional)
  • Paper has a chemical coating which reacts with bleach or eradication solutions to prevent forgers from altering written copy. If bleach is applied to a sheet the paper turns brown or a chemical void feature appears to make prescription form unusable
  • Security Prescription watermark printed on back
  • Microprint signature lines
  • A choice of either "Prescription is void if more than one controlled substance prescription is written per blank" or "___ Prescription is void if the number of drugs prescribed is not noted". This feature keeps patients from adding an additional prescription to a prescription form after it has been written by a physician

Legend

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Prescription
Hazmat-Chargeable
Hazmat-No Charge
MSDS / SDS
List 1
No Freeze
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