PHARMACEUTICALS LASER PRESCRIPTION FORMS A E I C B F J State-Approved Laser Prescription Blank Forms * Forms comply with the most current individual state regulations * All papers meet "tamper-resistant" Medicaid requirements effective October 2008 * Paper size: 81⁄2"W x 11"H A Alaska Full Sheet with Detachable Top-Left Script (367-5867) 500 per Pkg 2 Pkg@ B Florida Full Sheet (367-7818) 1000 per Pkg 2 Pkg@ C Florida Full Sheet with Detachable Top-Left Script (367-7821) 1000 per Pkg 2 Pkg@ D Florida 1⁄2 Perforated Sheet (367-7819) 1000 per Pkg 2 Pkg@ E Florida 1⁄4 Perforated Sheet (367-7820) 1000 per Pkg 2 Pkg@ F Georgia Full Sheet (367-7862) 500 per Pkg 2 Pkg@ 902 www.henryscheindental.com 70.29 66.29 225.99 215.99 226.99 216.99 220.99 210.99 220.99 210.99 85.99 80.99 D G H K L G Indiana Full Sheet with Detachable Top-Left Script (367-5294) 500 per Pkg 2 Pkg@ H Kentucky Full Sheet with Detachable Top-Left Script (367-5861) 500 per Pkg 2 Pkg@ I Washington State Full Sheet (367-7298) 500 per Pkg 2 Pkg@ J Washington State Full Sheet with Detachable Top-Left Script (367-7300) 500 per Pkg 2 Pkg@ K Washington State 1⁄2 Perforated Sheet (367-7295) 500 per Pkg 2 Pkg@ L Washington State 1⁄4 Perforated Sheet (367-7299) 500 per Pkg 2 Pkg@ * All products featured here are NOT for use in other states. 85.99 80.99 85.99 80.99 85.99 80.99 85.99 80.99 85.99 80.99 70.29 66.29http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675294%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675867%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675861%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677818%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677298%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677821%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677300%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677819%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677295%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677820%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677299%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677862%26CatalogName%3DDENTAL http://www.henryscheindental.com