Categories: Clinical Forms : Prescription Blanks
070292789_1D

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

Patterson Office Supplies
Patterson Item #: 70292797
Mfg Item #: VJO-PTC16-PAT3
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Specifications

# of Parts:
2 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:
Two-Part Carbonless stock; First part – 26 lb white security paper CB, Second Part – 20 lb yellow CF
Package Quantity:
100 Sets/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.
  • Void Pantograph – The word "Void" appears when document is photocopied
  • 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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