Prescription Pads

Prescription Pads
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Prescription Pads

50 Security forms per pad. Size of pad: 5" x 7" Exceeds California Department of Justice Security Printer Program & SB151 security requirements. Use this style when prescribing multiple drugs (up to three per scrip). Up to eight prescribers and/or locations may be included in the imprint area at top of form. Second part transfers the information you write (patient name, DOB, medication prescribed, etc.) from the top copy. No other printing on part two. Refer to the price list for current pricing and ordering increments.

  • Size: 5" x 7"
  • Paper: Rx Security Scrip
  • Ink: Blue & Black

Two-Part Large-Size Pads - Up to 3 Medications

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Two-Part Large-Size Pads - Up to 3 Medications   (PL2)
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Description:

50 Security forms per pad. Size of pad: 5" x 7" Exceeds California Department of Justice Security Printer Program & SB151 security requirements. Use this style when prescribing multiple drugs (up to three per scrip). Up to eight prescribers and/or locations may be included in the imprint area at top of form. Second part transfers the information you write (patient name, DOB, medication prescribed, etc.) from the top copy. No other printing on part two. Refer to the price list for current pricing and ordering increments.
Size: 5" x 7"
Paper: Rx Security Scrip
Ink: Blue & Black
Form ID: PL2


  1. Enter Quantity

    2. Pricing Matrix:

    Two-Part Large Size (5 x 7)
    50-Scripts Per Pad - Part Two Blank
    No. of Pads No. of Scripts Price Per Pad Total Price
    1 50 $98.00 $98.00
    5 250 $50.45 $252.25
    10 500 $31.30 $313.00
    20 1000 $26.40 $528.00
    25 1250 $26.30 $657.50
    40 2000 $21.95 $878.00
    50 2500 $20.60 $1,030.00
    Senate Bill 151 Frequently Asked Questions
    All items marked with an asterisk * are required.

  3. *Include Name of Medical Practice on Script?

  5. *Include Type of Medical Practice on Script?

  10. *Fax number on scripts?

  13. *DEA Registration is Required. You May:

  14. Attach DEA Registration:

    Attach a File

  16. Additional Prescriber Information for additional prescribers, please include Name, License Number, and Federal Controlled Substance/DEA No.

  18. Additional Location Information for additional locations, please provide Address, City, State, and Zip of each location

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