Item# PC4-WY WY 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-WY
WY Tamper Resistant Prescription Pads
Standard Wyoming Tamper Resistant Prescription pad, 1-part, 100 per pad, Size: 5 1/2" x 4 1/4", black ink. Includes all security features required by Wyoming for non-electronically transmitted Medicaid prescriptions as well as Level II thru Level V prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS.
Imprinted with black ink. List up to 4 doctors, 5 line maximum. Please type imprint information. Be sure to include; Physician name, Specialty, DEA number, License number and address.