Must be used for all prescriptions effective October 1, 2008. Our Medicaid mandated alter-resistant security prescription blanks exceed the mandated requirements.
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. Choose from one or two-part Rx's. Size: 5-1/2" x 4-1/4". Submit your personalized information using our attached Medicaid 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, complete the form, and fax or mail. Also available in a larger Jumbo size.
Click here to view the requirements that apply to Medicaid Rx Forms used in your state.
An alter-resistant blank sheet (8-1/2" x 11") is also available, without personalization, for laser printers.
Don't see what you are looking for or need additional assistance? Call us at (800) 242-2376.
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