102 Products
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Blue Laser Statement LCS102-BK
- #20 white laser bond paper with distinctive shaded colored background
- Heading information is computer generated
- "Remittance Portion" included at the top of the form
- This paper includes horizon perforation 3-9/16" from top edge
- Back of form is blank
- Folds easily into our self-seal double window statement envelope
- 500 sheets per pack
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Blue Laser Statement LCS107-BK
- #20 white laser bond paper with distinctive shaded colored background
- Includes Mastercard, Visa Discover, and American Express accepted on front
- Heading information is computer generated
- Remittance Portion included at the top of the form
- This paper includes horizon perforation 3-9/16" from top edge
- Information Change and credit card payment information is provided on the back of the Remittance Portion
- Folds easily into our self-seal double window statement envelope
- 500 sheets per pack
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Blue Laser Statement Paper LCS101-BK
- #20 white laser bond paper with distinctive shaded colored background
- Heading information is computer generated
- "Remittance Portion" included at the top of the form
- This paper includes horizon perforation 3-9/16" from top edge
- Information Change Format is provided on the back of the Remittance Portion
- Folds easily into our self-seal double window statement envelope
- 500 sheets per pack
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Blue Laser Statement Paper LCS101MC-BK
- #20 white laser bond paper with distinctive shaded colored background
- Includes Mastercard and Visa accepted on front
- Heading information is computer generated
- "Remittance Portion" included at the top of the form
- This paper includes horizon perforations 3-9/16" from top edge
- Information Change and credit card payment information is provided on the back of the Remittance Portion
- Folds easily into our self-seal double window statement envelope
- 500 sheets per pack
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Blue Laser Statement Paper LCS103-BK
- #20 white laser bond paper with distinctive shaded colored background
- Heading information is computer generated
- Front of form is completely blank
- This paper includes horizon perforation 3-9/16" from top edge
- Information Change Format is provided on the back of the Remittance Portion
- Folds easily into our self-seal double window statement envelope
- 500 sheets per pack
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Blue Laser Statement Paper LCS106-BK
- #20 white laser bond paper with distinctive shaded colored background
- Includes Mastercard, Visa and Discover accepted on front
- Heading information is computer generated
- Remittance portion included at the top of the form
- This paper includes horizon perforation 3-9/16" from top edge
- Information Change and credit card payment information is provided on the back of the Remittance Portion
- Folds easily into our self-seal double window statement envelope
- 500 sheets per pack
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Blue Statement Paper LCS100-BK
- #20 white laser bond paper with distinctive shaded colored background
- Heading information is computer generated
- "Remittance Portion" included at the top of the form
- This paper includes horizon perforation 3-9/16" from top edge
- Folds easily into our self-seal double window statement envelope
- 500 sheets per pack
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Burgundy Laser Statement Paper LCS104-BK
- #20 white laser bond paper with distinctive shaded colored background
- Includes Mastercard, Visa and Discover accepted on front
- Heading information is computer generated
- "Remittance Portion" included at the top of the form
- This paper includes horizon perforation 3-9/16" from top edge
- Information Change and credit card payment information is provided on the back of the Remittance Portion
- Folds easily into our self-seal double window statement envelope
- 500 sheets per pack
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Burgundy Laser Statement Paper LCS105-BK
- #20 white laser bond paper with distinctive shaded colored background
- Includes Mastercard and Visa accepted on front
- Heading information is computer generated
- "Remittance Portion" included at the top of the form
- This paper includes horizon perforation 3-9/16" from top edge
- Information Change and credit card payment information is provided on the back of the Remittance Portion
- Folds easily into our self-seal double window statement envelope
- 500 sheets per pack
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Burgundy Laser Statement Paper LCS108-BK
- #20 white laser bond paper with distinctive shaded colored background
- Heading information is computer generated
- Remittance Portion included at the top of the form
- This paper includes horizon perforation 3-9/16" from top edge
- Information Change Format is provided on the back of the Remittance Portion
- Folds easily into our self-seal double window statement envelope
- 500 sheets per pack
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California Rx Paper RxL825
- This prescription paper is 8-1/2 x 11 inches and provides space for up to THREE medications to be prescribed .
- The format will fit five lines of text, including the Practice Name, two providers and two addresses, or any combination of the three.
- Back Printing is available for an additional charge if more space is needed for additional providers or addresses.
- Each Provider's License and DEA must be pre-printed on the prescription. Please include this information in the imprint section, when placing order.
- All prescriptions in California must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
- 1,000 sheets per pack
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California Rx Paper RxL775
- This prescription paper is 8-1/2 x 11 with the 5-1/2 x 4-1/4 inch script in the upper left corner.
- The format will fit five (5) lines of text, including the Practice Name, Two (2) Providers and Two (2) Address, Or any combination of the three.
- Back Printing available for an additional charge if more space is needed for additional providers or addresses.
- Each Providers License and DEA must be pre-printed on the prescription. Please include this information in the imprint section, when placing order.
- All prescriptions in California must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
- 1,000 sheets per pack
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Delaware Prescription Pads
- This prescription is approved for use in Delaware and meets all state and federal regulations.
- This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
- All prescriptions come with Consecutive Numbering as required by the state (PLEASE SELECT YES IN THE CONSECUTIVE NUMBER BOX WHEN ASKED) .
- Back Print: Select YES if you need additional providers or addresses printed on the backside of the prescription. There is an additional charge for back printing.
- 20 Pads Per Pack
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Double Window Statement Envelopes SS9
- Self-seal double window envelopes are easy to use
- No moisture needed
- Includes fold up adhesive flap and a fold down envelope flat that seal when pressed together
- Window size 4-1/8" x 1"
- Bottom window position is 5/8" from bottom edge and 3/8" from left edge
- 1,000 per carton
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Florida Prescription Pads
- Micro Format, Inc. is an approved Florida State prescription printer.
- This prescription is approved for use in Florida and meets all state and federal regulations.
- All prescriptions are printed with the required Acute & NonAcute Pain Exception boxes, and required Florida State Batch Number.
- This prescription pad is designed for use when prescribing only one medication and includes the following text at the bottom of the prescription: “PRESCRIPTION IS VOID IF MORE THAN ONE (1) PRESCRIPTION IS WRITTEN PER BLANK”.
- This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
- Consecutive Numbering: Select YES if you would like your prescriptions numbered. There is an additional charge for numbering.
- Back Print: Select YES if you need additional providers or addresses printed on the backside of the prescription. There is an additional charge for back printing.
- 20 Pads Per Pack
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Georgia Prescription Pads
- This prescription is approved for use in Georgia and meets all state and federal regulations.
- This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
- These pads come consecutive numbered
- Back Print: Select YES if you need additional providers or addresses printed on the backside of the prescription. There is an additional charge for back printing.
- 20 Pads Per Pack
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Indiana Prescription Pads
- This prescription is approved for use in Indiana and meets all state and federal regulations.
- This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank white carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
- Consecutive Numbering: Select YES if you would like your prescriptions numbered. There is an additional charge for numbering.
- Back Print: Select YES if you need additional providers or addresses printed on the backside of the prescription. There is an additional charge for back printing.
- 20 Pads Per Pack
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Kentucky Prescription Pads
- This prescription is approved for use in Kentucky and meets all state and federal regulations.
- This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover. <
- Consecutive Numbering: Select YES if you would like your prescriptions numbered. There is an additional charge for numbering.
- Back Print: Select YES if you need additional providers or addresses printed on the backside of the prescription. There is an additional charge for back printing.
- 20 Pads Per Pack
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Louisiana Prescription Pads
- This prescription meets all state and federal regulations for use in Louisiana.
- This prescription pad is designed for use when prescribing one or more medications.
- This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
- Consecutive Numbering: Select YES if you would like your prescriptions numbered. There is an additional charge for numbering.
- Back Print: Select YES if you need additional providers or addresses printed on the backside of the prescription. There is an additional charge for back printing.
- 20 Pads Per Pack
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Maine Prescription Pads
- This prescription is approved for use in Maine and meets all state and federal regulations.
- This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
- Consecutive Numbering: Select YES if you would like your prescriptions numbered. There is an additional charge for numbering.
- Back Print: Select YES if you need additional providers or addresses printed on the backside of the prescription. There is an additional charge for back printing.
- 20 Pads Per Pack
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Massachusetts Prescription Pads
- This prescription is approved for use in Massachusetts and meets all state and federal regulations.
- This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
- Consecutive Numbering: Select YES if you would like your prescriptions numbered. There is an additional charge for numbering.
- Back Print: Select YES if you need additional providers or addresses printed on the backside of the prescription. There is an additional charge for back printing.
- 20 Pads Per Pack
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Missouri Prescription Pads
- This prescription is approved for use in Missouri and meets all state and federal regulations.
- This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
- Consecutive Numbering: Select YES if you would like your prescriptions numbered. There is an additional charge for numbering.
- Back Print: Select YES if you need additional providers or addresses printed on the backside of the prescription. There is an additional charge for back printing.
- 20 Pads Per Pack
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New Jersey APN Pad
- This prescription pad is 4 x 5-1/2 inches.
- New Jersey law requires only ONE Advance Practice Nurse's name per script with ONE Collaborative Physician's name. Both the Advance Practice Nurse's name and information plus the Collaborative Physician's name and information must be pre-printed on script.
- This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
- Back Printing available for an additional charge if additional addresses are desired.
- All prescriptions in New Jersey must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
- 10 Pads per Pack
