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Custom Imprinted
Tamper Resistant
KENTUCKY PRESCRIPTION PADS
This site is designed for use by
DOCTORS, HEALTHCARE PROFESSIONALS and MEDICAL CLINICS
Proper documentation is required to order documents from this site.
Tamper Resistant Rx PADS for DOCTORS and MEDICAL CLINICS
Micro Format Tamper Resistant Rx Pads meet ALL Medicaid Requirements.
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The following is an excerpt from the August 2007 letter sent to all State Medicaid Directors;
"Several States have laws and regulations concerning mandatory, tamper-resistant prescription pad programs,
which were in effect prior to the passage of section 7002(b). CMS deems that the tamper-resistant prescription pad
characteristics required by these States' laws and regulations meet or exceed the baseline standard, as set forth above."
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Kentucky Prescription Rx Pads
(Available 1 part and 2 part)
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Standard Format Rx Pads are approved for issuing "fraud proof" Medicaid Scripts.
All Prescription Pad Orders MUST BE ENTERED ON LINE
We cannot accept orders for prescription pads by Fax.
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Back Printing 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 below.
SECURE PRESCRIPTION PAD PRICE LIST
To ORDER - CLICK ON "Add to your Shopping Cart"
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Number of Pads Required
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One Part
(single script) Pads
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Two Part
Pads
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20 pads
1 part-100 sheets/pad
2 part-50 sets/pad
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20 pads
ONE
PART
SCRIPTS
$7.75
per pad
plus shipping
by UPS
Click to PURCHASE this item
20 Pads WITH
NUMBERING
$10.25/pad
Click to PURCHASE this item
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20 pads
TWO
PART
SCRIPTS
$10.25
per pad
plus shipping
by UPS
Click to PURCHASE this item
20 Pads WITH
NUMBERING
$12.50/pad
Click to PURCHASE this item
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40 pads
1 part-100 sheets/pad
2 part-50 sets/pad
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40 pads
ONE
PART
SCRIPTS
$6.00
per pad
plus shipping
by UPS
Click to PURCHASE this item
40 Pads WITH
NUMBERING
$8.50/pad
Click to PURCHASE this item
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40 pads
TWO
PART
SCRIPTS
$8.00
per pad
plus shipping
by UPS
Click to PURCHASE this item
40 Pads WITH
NUMBERING
$11.50/pad
Click to PURCHASE this item
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80 pads
1 part-100 sheets/pad
2 part-50 sets/pad
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80 pads
ONE
PART
SCRIPTS
$5.00
per pad
plus shipping
by UPS
Click to PURCHASE this item
80 Pads WITH
NUMBERING
$7.50/pad
Click to PURCHASE this item
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80 pads
TWO
PART
SCRIPTS
$6.00
per pad
plus shipping
by UPS
Click to PURCHASE this item
80 Pads WITH
NUMBERING
$9.50/pad
Click to PURCHASE this item
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160 pads
1 part-100 sheets/pad
2 part-50 sets/pad
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160 pads
ONE
PART
SCRIPTS
$4.75
per pad
plus shipping
by UPS
Click to PURCHASE this item
160 Pads WITH
NUMBERING
$7.00/pad
Click to PURCHASE this item
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160 pads
TWO
PART
SCRIPTS
$5.50
per pad
plus shipping
by UPS
Click to PURCHASE this item
160 Pads WITH
NUMBERING
$8.50/pad
Click to PURCHASE this item
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Micro Format Tamper Resistant Rx Pads meet ALL Kentucky and
Medicaid Requirements.
Micro Format Secure Rx Pads contain the following security features:
Hidden Message Technology ~
"VOID" pantograph
Distinctive GREEN Colored Background
Green background Erasure Protection
Security watermark on reverse side of prescription
Thanks to multiple security features, it is virtually IMPOSSIBLE TO ACCURATELY DUPLICATE a script written on Micro Format Security Script paper.
It is important to note that copier technology is ever changing.
Thus messages hidden on all Document Security Paper, including Secure Prescription Paper,
will appear most of the time.
However "hidden VOID messages" cannot be guaranteed to appear 100% of the time
when used with all copiers or scanners.
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For additional information relative to SECURITY PRESCRIPTION FORMS,
contact Micro Format, Inc. support@RxPaper.com
Copyright © 2000- Micro Format, Inc., All Rights Reserved
Micro Format, Inc.
Phone: 920-859-0500
Toll Free: 833-322-1882
Email: CustServ@RxMicroFormat.com
Address: 1434 Progress Lane, Omro, WI 54963
rev 2/15
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