OFFICE SUPPLIES CLINICAL FORMS LASER PRESCRIPTION FORMS A B * Conveniently print prescriptions from your practice software or computer programs * All papers meet " tamper-resistant " Medicaid requirements * Configurations available in full sheets (A), half-perforated sheets (C), and quarter-perforated sheets (D) * Dentrix-compatible blanks (B) feature a 51 from the top left ⁄2 " W x 11 " H ⁄2 " W x 41 ⁄4 " H script that detaches * " Color Change Ink " security feature paper (E) available for added security (not required by Medicaid) * Paper size: 81 A. Full Sheet (367-9217).................... 500 Sheets per Pkg. 2 Pkg.@ B. Full Sheet with Detachable Top Left Script (367-5299)................... 500 Sheets per Pkg. 2 Pkg.@ C. 1 ⁄2 Perforated Sheet (367-5297)....................500 Sheets per Pkg. 2 Pkg.@ * All products featured above are NOT for use in states that require state-approved prescription blanks. D. 1 ⁄4 Perforated Sheet (367-5298)................... 500 Sheets per Pkg. 2 Pkg.@ E. Full Sheet with Color-Changing Ink (367-6658)................... 500 Sheets per Pkg. 2 Pkg.@ E C D (368-3628) ADA® Front (Back not shown) 2021 HEALTH HISTORY FORMS * Reflects the latest AHA premedication guidelines * Clear, 2-sided layout and simple wording * Includes questions related to intravenous bisphosphonates and alendronates Adult-English (368-3628)..........................................100 per Pad TOOTH CLIPBOARD (366-4493).................................................................. Ea. * Patients will enjoy using these white acrylic clipboards * Size: 151 ⁄2 " H x 101 ⁄2 " W C. HIPAA PATIENT SIGN-IN SHEETS * Removable strip protects patient privacy * Carbon sheet transfers names to the back sheet * Available in 3 colors * 81 ⁄2 " W x 11 " H, 1-sided Sheets .................................................. 125 per Pkg. 5 Pkg. @ Specify: Burgundy Blue (366-7684) (366-7683) For pricing information and/or to place an order, visit: www.henryscheindental.com Green (366-7685) 966 Compatible with Compatible with Compatible with Compatible withhttp://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3679217%26CatalogName%3DDENTAL%26utm_source%3DDental%26utm_medium%3DNxtbook%26utm_campaign%3Dsupplies20232024-pagination%26utm_term%3D3679217 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675298%26CatalogName%3DDENTAL%26utm_source%3DDental%26utm_medium%3DNxtbook%26utm_campaign%3Dsupplies20232024-pagination%26utm_term%3D3675298 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675299%26CatalogName%3DDENTAL%26utm_source%3DDental%26utm_medium%3DNxtbook%26utm_campaign%3Dsupplies20232024-pagination%26utm_term%3D3675299 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3676658%26CatalogName%3DDENTAL%26utm_source%3DDental%26utm_medium%3DNxtbook%26utm_campaign%3Dsupplies20232024-pagination%26utm_term%3D3676658 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675297%26CatalogName%3DDENTAL%26utm_source%3DDental%26utm_medium%3DNxtbook%26utm_campaign%3Dsupplies20232024-pagination%26utm_term%3D3675297 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3664493%26CatalogName%3DDENTAL%26utm_source%3DDental%26utm_medium%3DNxtbook%26utm_campaign%3Dsupplies20232024-pagination%26utm_term%3D3664493 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3683628%26CatalogName%3DDENTAL%26utm_source%3DDental%26utm_medium%3DNxtbook%26utm_campaign%3Dsupplies20232024-pagination%26utm_term%3D3683628 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3667684%26CatalogName%3DDENTAL%26utm_source%3DDental%26utm_medium%3DNxtbook%26utm_campaign%3Dsupplies20232024-pagination%26utm_term%3D3667684 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3667685%26CatalogName%3DDENTAL%26utm_source%3DDental%26utm_medium%3DNxtbook%26utm_campaign%3Dsupplies20232024-pagination%26utm_term%3D3667685 http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3667683%26CatalogName%3DDENTAL%26utm_source%3DDental%26utm_medium%3DNxtbook%26utm_campaign%3Dsupplies20232024-pagination%26utm_term%3D3667683 http://www.henryscheindental.com