Custom Imprinted
Tamper Resistant
PRESCRIPTION PADS

Tamper Resistant Rx PADS for DOCTORS and MEDICAL CLINICS
Micro Format Tamper Resistant Rx Pads meet ALL Medicaid Requirements.

Protect your medical prescriptions from unauthorized duplication with
High Security TWO PART Prescription Pads

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Choose Your Format.

Format Rx610
for prescribing ONE or MORE MEDICATIONS per script.

Format Rx620 (shown above) for prescribing only ONE MEDICATION per script. Script includes the following text at the bottom of the script.
“PRESCRIPTION IS VOID IF MORE THAN ONE (1) PRESCRIPTION IS WRITTEN PER PAGE”

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

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Back Printing on part 1 is available at an additional $5.00 per pad
This amount will be added when your order is processed.
This additional charge for back printing will not be shown
at the time you place your order. However it will be added
to the total cost of your order.

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This link will provide additional information on the
Requirement for Use of Tamper Resistant Prescription Pads Under the Medicaid Program, under Section 1903b(i) of the Social Security Act (42 USC193b(i), paragraph (23)

Format Rx620 includes the following text at the bottom of the script. “PRESCRIPTION IS VOID IF MORE THAN ONE (1) PRESCRIPTION IS WRITTEN PER PAGE”
Rx620 ~ SECURE Rx PAD PRICE LIST To ORDER - CLICK ON "Add to your Shopping Cart"
50 sets per pad with wrap-a-round cover	Rx620 TWO PART Pads
ITEM# Rx620 Script Size: 5-1/2" x 4-1/4" Imprint up to 4 Names (3 Names plus Facility) Rx620 For prescribing ONLY ONE MEDICATION To Order ... click on the "Add to Your SHOPPING CART" button.	20 pads $9.10 per pad plus shipping by UPS 20 Pads WITH NUMBERING $11.34 per pad plus shipping by UPS 40 pads $7.87 per pad plus shipping by UPS 40 Pads WITH NUMBERING $9.79/pad plus shipping by UPS 80 pads $5.67 per pad plus shipping by UPS 80 Pads WITH NUMBERING $7.23/pad plus shipping by UPS 160 pads $4.49 per pad plus shipping by UPS 160 Pads WITH NUMBERING $5.94/pad plus shipping by UPS