Categories: Clinical Forms : Prescription Blanks
0112102_DDS_WV_Laser

West Virginia Laser Prescription Blanks – Nonpersonalized, 8-1/2" W x 11" H (Overall) , 5-1/2" W x 4-1/4" H (Detached), 100/Pkg

Patterson Office Supplies
Patterson Item #: 70112102
Mfg Item #: VJO-112102-PAT3
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Specifications

# of Parts:
1 part
Design Color:
Green
Dimensions:
8-1/2" W x 11" H (overall)
Manufacturer Name:
PATTERSON OFFICE SUPPLIES
Material:
20 lb Offset
Package Quantity:
100/Pkg
Product Color:
White
Security Features:
  • The face of each blank lists security features
  • Void pantograph printed in pantone green ink –“Void” appears when photocopied.
  • Opaque “Rx” in upper right corner
  • “West Virginia Security Prescripiton” watermark prints on back of each blank
  • Quantity check-off boxes printed on each blank
  • This prescription may be filled with a generically equivalent drug product unless the words “Brand Medically Necessary” are written, in the practitioner's own handwriting, on this prescription form" printed on each blank.
  • Consecutive numbering available at an additional charge on item 051-1238, call for details.
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.