15DC2770_Clinical Forms_173-196 2/13/15 11:03 AM Page 183 Laser Prescription Forms le with Compatib A CLINICAL FORMS Compatib le with B C D LASER PRESCRIPTIONÂ FORMS * 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) * Dentrix-compatible blanks (B) feature a 51/2"W x 41/4"H script that detaches from the top left * "Color Change Ink" security feature paper (E) available for added security (not required by Medicaid) * Paper size: 81/2"W x 11"H A. Full Sheet (367-9217) .........................500 per Pkg. 69.99 2 Pkg.@ 65.99 D. 1/4 Perforated Sheet (367-5298) .............................500 per Pkg. 2 Pkg.@ 69.99 65.99 B. Full Sheet with Detachable Top Left Script (367-5299) .........................500 per Pkg. 69.99 2 Pkg.@ 65.99 E. Full Sheet with Color-Changing Ink (367-6658) .............................500 per Pkg. 2 Pkg.@ 69.99 65.99 C. 1/2 Perforated Sheet (367-5297)..............................500 per Pkg. 2 Pkg.@ 69.99 65.99 le with Compatib E * All products featured above are NOT for use in states that require state-approved prescription blanks. New Jersey California STATE-APPROVED LASER PRESCRIPTION PERSONALIZED FORMS * Forms comply with state-mandated personalization requirements * Paper size: 81/2"W x 11"H Full Sheet with Detachable Top-Left Script New Jersey (368-1725) ...................................................................................1000 per Box California (368-1734) ...................................................................................1000 per Box Imprinted Materials: 800.414.0940 8am-4:30pm (ET) 208.99 204.99 Laser Prescription Forms continued on next page. Call To Order: 800.372.4346 8am-9pm (ET) 183http://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%3D3675298%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%3D3676658%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%3D3681725%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3681734%26CatalogName%3DDENTAL