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, youâ€™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.
CA Semi-Custom Tamper Resistant Prescription Pads
Semi-Custom California Tamper Resistant Prescription pad, 1-part, 100 per pad, Maximum Size: 8 1/2" x 5 1/2". Black ink. 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.
â€¢Imprinted with black ink.
â€¢Second Part not Printed.
Special Ordering Requirements:
â€¢For each doctor in practice, fax to Ancom a valid DEA certificate complete with the doctor's signature. 330-225-3434.
â€¢Be sure to include; Name, Specialty, License # and DEA # for each doctor as well as one office address.
We may be able to use your logo if art files are in PDF format, AdobeÂ® PhotoshopÂ®, IllustratorÂ®, EPS or TIF. Art charges may apply to rearrange or resize your design, or if one of these formats is not available. Email logo to: email@example.com.
Ancom Business Products an InHealth Company