pharmaceuticals Laser Prescription Forms A le with le with Compatib E le with Compatib le with le with K Compatib L le with Compatib 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.@ 946 le with Compatib J le with Compatib H G Compatib Compatib le with Compatib F I D C B 85.99 81.99 226.99 216.99 226.99 216.99 219.99 209.99 219.99 209.99 92.99 86.99 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.@ 92.99 86.99 92.99 86.99 92.99 86.99 92.99 86.99 93.99 87.99 75.99 71.99 * All products featured here are NOT for use in other states. 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