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CA Approved Pads
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Select:
1-part 100 rx/pad
2-part 50 sets/pad
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Quantity:
5
10
20
40
60
80
100
120
Style:
Please Select
Standard Format (1 RX / Sheet)
Plus Format (3 RX / Sheet)
Add logo:
Please Select
No Logo
Repeat logo
New logo. (one-time $35 setup charge, upload new file at checkout)
Order Options:
2 part RX Wraparound Cover OPTION (add $1 per pad)
RX Numbering:
Please Select
1 part Rx/1st sheet: Included
2 part Rx OPTION: Number both sheets (adds $1 per pad)
Production Time:
Please Select
Standard Delivery Available
RUSH - Not available at this time
* Name/Address Option:
Please Select
Up to 5 combined names OR addresses
6-10 combined names OR addresses
11-15 combined names OR addresses
16-20 combined names OR addresses
Project Name:
4.25 x 5.5 CA RX Pads (Multiple Names / Multiple Addresses)
Multiple Providers & Addresses on One Rx Form
--see other products for single name / address.
California approved for controlled substance prescriptions.
Customizable to meet your needs.
Contains all required CA DOJ security features
Bar code and sequential number
CA DOJ approved format/wording
Choice of standard (1 line Rx) or plus (3 line Rx) formats.
Choice of 1-part or 2-part (with carbonless copy).
Available with optional wraparound cover.
Custom Designs Available--Call for Details
During checkout, please upload an Excel or Word file with the following information.
Be sure all infomation you provide is as you want it to appear on the pad:
Provider Names
DEA and License Numbers
NPI Numbers (if desired)
Addresses
Phone / Fax Numbers
Proofs will be provided in your account for approval. Be sure to view the proof.
Proof approval
MUST
be received before your order can proceed to printing.
CA law requires orders ONLY be shipped to the address of record on the DEA or Board License.
No exceptions can be made. This is required by CA prescription law.