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.
NJ Tamper Resistant Prescription Pads
Used by: Ceritfied Nurse Midwives. Standard New Jersey Tamper Resistant Prescription pad, black ink, numbered, 1-part, 100 per pad, Size: 4" x 5 1/2". Price per pad. Due to file size, the NJ pads are partially detailed. Includes all security features required by New Jersey for non-electronically transmitted prescriptions. PRICE IS PER PAD, MINIMUM ORDER IS 10 PADS.
•Please type imprint information. Be sure to include; Physician name, Practice name, Specialty, DEA number, License number and address. License Verification Required.
•For each doctor, please fax to Ancom a copy of the valid DEA certificate with the doctor's signature and shipping address on it. 330-225-3434. NOTE: The actual "ship to" address of the order must match the address on the DEA certificate.
Ancom Business Products an InHealth Company