Item# PC4-CA-3 CA Tamper Resistant Prescription Pads

Ancom has designed and printed over 1,000 custom professional forms for our customers, including the Healthcare industry, whose offices have relied on our stock professional forms for years. At Ancom, you’ll find the ready-made forms that you need: HIPAA forms, HCFA forms, ADA forms, and Rx pads, along with X-Ray mailers, recall postcards, laser statements and mailing envelopes. To get started on designing your own custom professional form, see our Custom Forms section.

Item# PC4-CA-3  CA Tamper Resistant Prescription Pads

Item# PC4-CA-3

CA Tamper Resistant Prescription Pads

Standard California Tamper Resistant Prescription pad, 3-part, 50 per pad, Size: 5 1/2" x 4 1/4", black ink, part 2 not printed. Includes all security features required by California for non-electronically transmitted Medicaid prescriptions as well as Level 11 thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS.

Product Details:

•Imprinted with black ink.

•Second Part not Printed.

•List up to 4 doctors, 5 line maximum.

Special Ordering Requirements:

•For each doctor in practice, fax to Ancom a valid DEA certificate complete with the doctor's signature. 330-225-3434.

•Please type imprint information. Be sure to include; Name, Specialty, License # and DEA # for each doctor as well as one office address.