Security Features Include: Tamper Resistant Green or Blue Background Detects Erasures, Void Pantograph, Security Paper w/Invisible Ultra-Violet Fibers & Protection Against Bleach or Solvent Washing, Security Features Listed On Back.
The background pattern appears on both sides of the first part of the prescription blank and makes any erasure immediately apparent. On the two-part format, the second part has screened "VOID" copy printed across it. Available in a horizontal or vertical format, these alter-resistant blanks can be faxed or copied for your files. Meets Medicaid Security Requirements. Choose from one or two-part Rx's. Size: 5-1/2" x 4-1/4". Submit your personalized information using our attached Alter-Resistant Rx/Prescription Blanks Standard Size order layout*.
Simply click on our attached, easy to use order form above. Our order layout also includes all ordering specifications & pricing. Simply print the order layout, complete the form, and fax or mail. Also available in a larger Jumbo size.
Meets October 1, 2008 Medicaid Security Requirements. An alter-resistant blank sheet (8-1/2" x 11") is also available, without personalization, for laser printers.
Click here to view the requirements that apply to Rx Forms used in your state.
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