Ingenix
APPROVED FORMAT
MEDICAL SCRIPTS

Manufactured by Micro Format, Inc.
www.RxPaper.com/optum
Secure Laser Prescription ( Rx ) Paper
for Doctors, Healthcare Professionals & Medical Clinics


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 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 Registration form on file.

Please FAX a copy the DEA Certificate for EACH DOCTOR
who's name appears on the script. Fax the DEA Certificate(s) to
MICRO FORMAT Customer Service
Fax Number: (847)520-0197

Thank you.

Once we receive the required DEA Registration Certificate(s),
it will be reviewed along with your order form.
After it has been determined that everything is completed,
your order will be processed.


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.
  • Printing additional names and/or locations on the back of the script is
    available at an additional charge of $75.00 per 1000.

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


California Approved Laser Prescription Paper
Item #RxL825
Sheet Size: 8-1/2" x 11"


RxL825
Item# RxL825
Script Size:
5-1/2" x 4-1/4"
Imprint up to 8 Names

To order ........
Click On
"Add to Shopping Cart"


Item# RxL825
1,000 sheets ~ $319.00
plus shipping
by UPS


Item# RxL825
2,000 sheets ~ $435.00
plus shipping
by UPS


Item# RxL825
4,000 sheets ~ $795.00
plus shipping
by UPS


Item# RxL825
8,000 sheets ~ $1,337.00
plus shipping
by UPS



Thank You for your order for Secure California Prescription Forms.
We appreciate your business.
Your order will ship in approximately 10 to 12 business days.
Please allow up to 4 days for shipping by UPS.

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 ~ In USA Toll Free 800-333-0549
Fax 847/520-0197

rev 11/2017