California
TAMPER RESISTANT
Rx Pads

Custom Imprinted
Medical Prescription Scripts
for use in the State of California
~ This is a SECURE Order Form ~

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.

After you complete your order ...
The California Department of Justice requires that a copy of your DEA Certificate 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 Certificate form on file.
Please FAX a copy of your DEA Certificate to
MICRO FORMAT Customer Service
Fax Number: (847)520-0197
Once we receive your DEA 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.

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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.

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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.

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

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NOTE: ALL CALIFORNIA SCRIPTS CONTAIN REFILL CHECK BOXES as required by the State of California
Pad Sizes Available
Script Size: 5-1/2" x 4-1/4" Item# Rx710 1 part secure prescription click to enlarge 2 Part Secure Prescription IMPORTANT: Part 2 is Blank click to enlarge	Two Oversize Secure Prescription Pads Available Script Size: 5" x 7" Item# Rx720 1 part secure prescription click to enlarge Script Size: 5" x 7" Item# Rx722 1 part secure prescription click to enlarge . . . .	Script Size: 8-1/2" x 3-2/3" Item# Rx730 1 part secure prescription click to enlarge 2 part Secure Prescription Pads click to enlarge
NOTE: ALL CALIFORNIA SCRIPTS CONTAIN REFILL CHECK BOXES as required by the State of California

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ONE PART SCRIPT: Distinctive BLUE California background 100 sheets per pad Click to ORDER 1 PART SCRIPTS

TWO PART SCRIPT: Part 1 has Distinctive BLUE California background Part 2 is a BLANK YELLOW sheet 50 sets per pad with wrap-a-round cover Click to ORDER 2 PART SCRIPTS

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"HIPAA" Compliant Patient Sign-In Log

Add an Additional Level of Security to your prescriptions with Tamper Evident Security Hologram Labels

Secure GuardTM Self Expiring Visitor Badges

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QUESTIONS: Please send us an e-mail support@rxpaper.com

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Copyright © 1995- Micro Format, Inc., All Rights Reserved
Micro Format, Inc.
830-3 Seton Court ~ Wheeling, IL 60090
Phone: 847/520-4699 ~ 800-333-0549
Fax 847/520-0197