TAMPER RESISTANT
LASER
California Rx Prescription Paper

California laser Rx Paper

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

Micro Format is a California State Approved manufacturer
for Tamper Resistant Prescription Pads
Micro Format Secure Prescription Paper contains all of the features
required by the California State Legislation.

ALL CALIFORNIA Rx FORMATS
MANUFACTURED BY MICRO FORMAT
ARE COMPLIANT WITH THE JANUARY 2019 REGULATION REQUIRING A SERIAL NUMBER

Notice to ALL in Medical Community
If you prescribe painkillers such as Vicodin, you MUST write or computer print your prescription on SECURE Rx Paper.

The move from Schedule III to Schedule II of highly addictive hydrocodone combination painkillers, such as Vicodin, took effect October 6, 2014.
Doctors, who under schedule III could prescribe a six-month supply as a 30-day prescription with up to five refills, are now limited to prescribing a three-month supply under schedule II. The rule also mandates that doctors must write the prescriptions in 30-day increments that can only be filled sequentially.
Pain patients using these drugs will have to visit their doctors every three months for a new prescription.
SecureGuard™ Rx Prescription Paper Products meets and exceeds the FDA Recommendations for prescribing controlled substance prescriptions.

FEDERAL REGISTER
The Daily Journal of the United States Government

After you complete your order ...
California Law 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 on the BACK of each script is available at an additional charge of $50.00 per 1000 sheets.
This charge will not show on your order at the time you enter your order.
This charge will be added to the invoice total when it is charged to your credit card.
This charge will be added to the total price of your order.

Included in this charge is printing THREE LINES of text copy
Information must fit into THREE LINES of TEXT copy.

Three lines of text copy may be:

THREE NAMES plus license numbers
TWO NAMES plus ONE LOCATION
THREE LOCATIONS
Other combination of names and locations

If additional information needs to be printed on the back of each script,
an additional COMPOSITION charge of $100.00 will be added to the total price for this order.
You will be required to sign a composition approval before your order will be printed.

For additional information please CALL Customer Service at (800)333-0549.

For a FACILITY to qualify as a
LICENSED HEALTH CARE FACILITY so you can order INSTITUTION style controlled substance prescription forms -- it must be a licensed facility pursuant to Article 1 (commencing with section 1250) of Chapter 2 of Division 2 of the California Health and Safety Code.

Article 1 Section 1250

Micro Format, Inc. is obligated by law to insure only those qualified can purchase medical prescription paper for use in the State of California. For Micro Format to manufacture INSTITUTION STYLE controlled substance prescriptions forms, we require an affidavit be signed attesting to the fact you have read
Article 1 Section 1250 of Chapter 2 of Division 2 of the California Health and Safety Code
and that your health care facility meets the necessary requirements.

Please click here for the required affidavit.
Licensed Health Care Facility AFFIDAVIT

ALL CALIFORNIA Rx FORMATS
MANUFACTURED BY MICRO FORMAT
ARE COMPLIANT WITH THE JANUARY 2019 REGULATION REQUIRING A SERIAL NUMBER

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"

NOTE: ALL CALIFORNIA SCRIPTS CONTAIN REFILL CHECK BOXES as required by the State of California

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

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

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

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