CLINICAL FORMS CLINICAL FORMS Laser Prescription Blanks A B C ble with Compati ble with Compati E D ble with Compati LASER PRESCRIPTION BLANKS • Conveniently print prescriptions from your practice software or computer programs • All papers meet “tamper-resistant” Medicaid requirements effective October 2008 • Configurations available in full sheets (A), half-perforated sheets (C), and quarter-perforated sheets (D) • “Color Change Ink” security feature paper (E) available for added security (not required by Medicaid) • Paper size: 8-1⁄2"W x 11"H Item# A. (367-9217) B. (367-5299) C. (367-5297) D. (367-5298) E. (367-6658) Description Full Sheet Full Sheet with Detachable Top Left Script 1/2 Perforated Sheet 1/4 Perforated Sheet Full Sheet with Color-Changing Ink Qty. 500/PK 500/PK Price $69.99 $69.99 2@ $65.99 $65.99 500/PK 500/PK 500/PK $69.99 $69.99 $69.99 $65.99 $65.99 $65.99 All products featured on this page are NOT for use in states which require state-approved prescription blanks. 142 www.henryscheindental.comhttp://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3679217%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675299%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675297%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675298%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3676658%26CatalogName%3DDENTAL http://www.henryscheindental.com