click on a state above to go directly to that pad
CALIFORNIA PRESCRIPTION
FORMS - Click here
for an approved distributor list.
Must be used for all Level ll
thru Level V prescriptions in CA. Imprinted with black ink, second part
not printed. Includes all the security features as required by the State
of California.
Padded Style available in 1 or 2 part Laser Style
FLORIDA PRESCRIPTION
FORMS - Click here
for an approved distributor list. (back to top)
Must be used for all Medicaid
prescriptions in Florida. Imprinted with blue ink, second part not
printed. Includes all security features required by State of Florida.
Padded Style available in 1 or 2 part Laser Style
HIGH SECURITY PRESCRIPTION
FORMS (back to top)
Can be used for all Level ll
thru Level V prescriptions for Medicaid Patients starting October 1st, 2007. Imprinted with black ink, second part
imprinted. Includes all the security features required by Medicaid. Contact us for specific information on requirements for your state.
Padded Style available in 1 or 2 part Laser Style
INDIANA PRESCRIPTION
FORMS (back to top)
Must be used for narcotic drugs in Indiana. Imprinted in reflex blue,
both parts printed the same. Includes all security features required
by State of Indiana, duplicate copy printed on second part.
Padded Style available in 1 or 2 part Laser Style
KENTUCKY PRESCRIPTION
FORMS (back to top)
Must be used for all narcotic drugs in Kentucky. Printed with void
pantograph on face, standard
layout, green ink for base copy and black ink for imprinted
information.
Padded Style available in 1 or 2 part Laser Style
MAINE PRESCRIPTION
FORMS (back to top)
Must be used for all narcotic drugs in Maine.
Imprinted in black ink, second part not printed. Includes all security
features as required by the State of Maine.
Padded Style available in 1 or 2 part Laser Style
NEW JERSEY PRESCRIPTION
FORMS - Click here
for an approved distributor list. (back to top)
Must be used for all prescriptions filled in New Jersey. Imprinted in
black ink, Eight different formats, second part not printed. Includes all
security features as required by the State of New Jersey.
Padded Style available in 1 or 2 part Laser Style
TAMPER RESISTANT PRESCRIPTION
FORMS - Click here
for an approved distributor list. (back to top)
Must be used for all Level ll
thru Level V prescriptions for Medicaid Patients starting October 1st, 2007. Imprinted with black ink, second part
not printed. Includes all the security features required by Medicaid. Contact us for specific information on requirements for your state.
Padded Style available in 1 or 2 part Laser Style
WASHINGTON PRESCRIPTION
FORMS - Click here
for an approved distributor list. (back to top)
Must be used for all Prescriptions starting July 1st, 2010. Imprinted with black ink.
Padded Style available in 1 or 2 part Laser Style
WEST VIRGINIA PRESCRIPTION FORMS (back to top)
Suggested but not required for
all narcotic drugs in West Virginia. Imprinted with black ink, second
part not printed. Includes all security features as required by the
state of West Virginia.
Padded Style available in 1 or 2 part Laser Style
WYOMING PRESCRIPTION
FORMS - Click here
for an approved distributor list. (back to top)
Must be used for all Level ll
thru Level V prescriptions in Wyoming. Imprinted with black ink, second part
not printed. Includes all the security features as required by the
Wyoming.
