www.CaliforniaRxPaper.com
www.CaliforniaPrescriptionPaper.com

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    TAMPER RESISTANT
    Rx Pads

    California Rx Pads

    Custom Imprinted
    Medical Prescription Scripts
    for use in the State of California

    ~ This is a SECURE Order Form ~


    Micro Format is a California State Approved
    manufacturer for Tamper Resistant Prescription Pads

    Micro Format Secure Prescription Pads contains all of the features
    required by the California State Legislation.



    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.

    View Features
    as the relate to the State and Medicaid Requirements.


    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.


    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.

    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.

    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
    Click to Enlarge

    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

    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



    "HIPAA" Compliant
    Patient Sign-In Log

    Patient Sign-In Logs Patient Sign-In Log

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

    Gold Security Hologram Labels

    Secure GuardTM
    Self Expiring Visitor Badges
    Self Expiring Visitor Badges

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


    rev 10/2015