TAMPER RESISTANT
LASER
California Rx Paper

California laser Rx Paper

Custom Imprinted
Laser Medical Prescription Script Paper
for use in the State of California

Micro Format, Inc. is a California State Pharmacy Board
and Department of Justice "approved printer"
for Secure Prescription Paper.
Micro Format Secure Prescription Paper contains all of
the features required by the California State Legislation.

After you complete your order ...
The California Department of Justice requires that a copy of your DEA Registration be sent to us by FAX.
This is a State requirement.
We cannot process any order for which we do not have a current DEA Registration form on file.
Please FAX a copy of your DEA Registration form to
MICRO FORMAT Customer Service
Fax Number: (847)520-0197
Thank you.
Once we receive your DEA Registration Certificate, it will be reviewed along with your order form. After it has been determined that everything is in order, your order will be processed.
PA prescription Authority Documentation
A PA must have their DEA registration AND supervising physician's information on their prescriptions.

California Law requires that a physician assistant authorized to write controlled substance drug orders pursuant to authority granted to them by their supervising physician and DEA registration, must have their supervising physician's name, DEA registration number, address, and telephone number preprinted on the physician assistant's preprinted controlled substance prescription form.

All Prescription Pad Orders MUST BE ENTERED ON LINE
We cannot accept orders for prescription pads by Fax. =

California Prescription Paper Imprinting Information
and your Credit Card Payment Information will be requested
AFTER you have clicked on the "Add to Your SHOPPING CART" button
Due to State of California Regulations, un-imprinted laser scripts are not available.

When Requested,
Please accurately fill-in the information that needs to be imprinted on the top of each sheet.

California law requires scripts must contain both the DEA# and License# for each doctor listed.

A copy of the DEA Registration for each doctor listed must be sent to us by FAX.

Under California Law ... ALL California Laser Prescription Paper
MUST BE SHIPPED to the address on file with the DEA

Printing additional names and/or locations on the back of the script is
available at an additional charge of $34.00 per 1000.
This charge will be added to the total price of your order.
For additional information please CALL Customer Service at (800)333-0549.

California Approved Laser Prescription Paper
Five Formats Available

Item #RxL775
Sheet Size: 8-1/2" x 11"

Item #RxL812
Sheet Size: 8-1/2" x 11"

Item #RxL785
Sheet Size: 5-1/2" x 8-1/2"

Item #RxL720
Sheet Size: 5" x 7"

Item #RxL810
Sheet Size: 8-1/2" x 11"

This product is printed with one set of the state required
QUANTITY CHECK BOXES

This product DOES NOT contain the state required
QUANTITY CHECK BOXES
If you use this format, your computer MUST print the required Check Boxes.

This product is printed with one set of the state required
QUANTITY CHECK BOXES

This product DOES NOT contain the state required
QUANTITY CHECK BOXES
If you use this format, your computer MUST print the required Check Boxes.

Item# RxL775
Script Size:
5-1/2" x 4-1/4"
Imprint up to 4 Names
(3 Names plus Facility)