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    Custom Imprinted
    Tamper Resistant

    Massachusetts Prescription Pads

    EFFECTIVE JULY 1, 2013
    All Prescriptions used in the State of Massachusetts
    MUST meet Medicaid Requirements.

    All Micro Format SecureGuard Prescription Paper Products
    MEET and EXCEED Medicaid Requirements

    High Security Prescription Pads
    (Available 1 part and 2 part)



    Rx640
    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 and exceed all Medicaid and Massachusetts Requirements.

    All Prescription Pad Orders MUST BE ENTERED ON LINE
    We cannot accept orders for prescription pads by Fax.
    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.
    VERY IMPORTANT

    "A prescription issued by a nurse practitioner, psychiatric nurse, physician assistant, nurse anesthetist or pharmacist shall also contain the name of the supervising physician."

    Massachusetts Secure Prescription Pad PRICE LIST
    Rx640
    To ORDER - CLICK ON "Add to your Shopping Cart"

    ONE PART
    (single script) Pads
    100 scripts per pad
    TWO PART
    Pads
    50 sets per pad
    with wrap-around cover
    20 pads
    ONE
    PART
    SCRIPTS
    $7.75
    per pad
    plus shipping
    by UPS

    Rx640
    Click to PURCHASE this item

    20 Pads
    ONE PART
    WITH
    NUMBERING
    $10.25 per pad
    plus shipping
    Rx640
    Click to PURCHASE this item
    		20 pads
    TWO
    PART
    SCRIPTS
    $10.25
    per pad
    plus shipping
    by UPS

    Rx640
    Click to PURCHASE this item

    20 Pads
    TWO PART
    WITH
    NUMBERING
    $11.50 per pad
    plus shipping
    Rx640
    Click to PURCHASE this item
    40 pads
    ONE
    PART
    SCRIPTS
    $6.00
    per pad
    plus shipping
    by UPS

    Rx640
    Click to PURCHASE this item

    40 Pads
    ONE PART
    WITH
    NUMBERING
    $8.25/pad

    Rx640
    Click to PURCHASE this item

    		40 pads
    TWO
    PART
    SCRIPTS
    $8.00
    per pad
    plus shipping
    by UPS

    Rx640
    Click to PURCHASE this item

    40 Pads
    TWO PART
    WITH
    NUMBERING
    $10.00/pad

    Rx640
    Click to PURCHASE this item

    80 pads
    ONE
    PART
    SCRIPTS
    $5.00
    per pad
    plus shipping
    by UPS

    Rx640
    Click to PURCHASE this item

    80 Pads
    ONE PART
    WITH
    NUMBERING
    $6.75/pad

    Rx640
    Click to PURCHASE this item

    		80 pads
    TWO
    PART
    SCRIPTS
    $6.00
    per pad
    plus shipping
    by UPS

    Rx640
    Click to PURCHASE this item

    80 Pads
    TWO PART
    WITH
    NUMBERING
    $7.50/pad

    Rx640
    Click to PURCHASE this item

    160 pads
    ONE
    PART
    SCRIPTS
    $4.75
    per pad
    plus shipping
    by UPS

    Rx640
    Click to PURCHASE this item

    160 Pads
    ONE PART
    WITH
    NUMBERING
    $6.25/pad

    Rx640
    Click to PURCHASE this item

    		160 pads
    TWO
    PART
    SCRIPTS
    $5.50
    per pad
    plus shipping
    by UPS

    Rx640
    Click to PURCHASE this item

    160 Pads
    TWO PART
    WITH
    NUMBERING
    $6.75/pad

    Rx640
    Click to PURCHASE this item

    Micro Format Tamper Resistant Rx Pads meet and exceed 2008 Medicaid Requirements.

    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)

    Micro Format Secure Rx Pads contain the following security features:

  • Hidden Message Technology ~
    "VOID" pantograph
    VOID

  • Distinctive BLUE Colored Background

  • Blue background Erasure Protection

  • Security watermark on reverse side of prescription

  • Rub coin on back to validate script

  • Security Warning Band on face and Security Features listed on back

  • Thermochromatic ink (color changing) Rx symbols on back

  • Unique Production Batch Number

    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.
    Under our licensing agreement, all orders for Document Security Paper are reviewed and the information provided is confirmed by our Document Security Compliance Team.
    The use of Script Paper is controlled by Federal and State Agencies.
    Any attempt to purchase script documents by unauthorized persons or by persons providing falsified information will be reported to the proper authorities for prosecution to the full extent of the law.

    Acceptance of any and all orders for Document Security Paper is at the discretion of the Micro Format Document Security Compliance Team.

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

    Gold Security Hologram Labels

    Ultrasound Thermal Printer Paper

    SecureGuardtm Maxwell Ultrasound Paper
    for use in hospitals, clinics, OB offices and others.
    Compatible ultrasound paper for use in Sony and Mitsubishi Ultrasound equipment

    If you dispense Sample Medications ...
    You need the SecureGuard™
    Sample Medication Label Recording System
    SAMPLE MEDICATION Recording System
    Meets Federal and State Regulations.
    SELF EXPIRING LABELS, VISITOR and NAME BADGES

    To activate Secure Name Badge

    Visitor Badge with journal

    Self Expiring Visitor Name Badge
    with Record Copy
    PATIENT SIGN-IN LOGS

    Spanish Patient Sign-In Form
    SecureGuard™Patient Sign-In Form
    Each "Sign-In Log" includes 20 sign-in label strips

    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. 
    830-3 Seton Court ~ Wheeling, IL 60090 
    847/520-4699 FAX 847/520-0197
    800-333-0549
    rev 7/2013