 www.CaliforniaPrescriptionPaper.com |
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www.CaliforniaPrescriptionPaper.com |
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Custom Imprinted
Medical Prescription Scripts
for use in the State of California
~ This is a SECURE Order Form
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Micro Format, Inc. is a California State Pharmacy Board
and Department of Justice "approved printer"
of Secure Prescription Pads.Micro Format Secure Prescription Pads contain all of
the features required by the California State Legislation.
View Features
as the relate to the 2009 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 DocumentationA 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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Item# Rx710 1 part secure prescription  click to enlarge 2 Part Secure Prescription 
IMPORTANT: click to enlarge |
| Item# Rx730 1 part secure prescription 
click to enlarge 2 part Secure Prescription Pads  click to enlarge |
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ONE PART SCRIPT: Distinctive BLUE California background 100 sheets per pad
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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
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