CLINICAL FORMS LASER PRESCRIPTION FORMS le with le with Compatib le with Compatib A Compatib B C D LASER PRESCRIPTION FORMS * Conveniently print prescriptions from your practice software or computer programs * All papers meet " tamper-resistant " Medicaid requirements effective October 2008 * Configurations available in full sheets (A), half-perforated sheets (C), and quarter-perforated sheets (D) * Dentrix-compatible blanks (B) feature a 51⁄2 " W x 41⁄4 " H script that detaches from the top left * " Color Change Ink " security feature paper (E) available for added security (not required by Medicaid) * Paper size: 81⁄2 " W x 11 " H A. Full Sheet (367-9217)���������������������� 500 per Pkg. 2 Pkg.@ B. Full Sheet with Detachable Top Left Script (367-5299)���������������������� 500 per Pkg. 92.99 86.99 2 Pkg.@ 92.99 86.99 2 Pkg.@ 92.99 86.99 C. 1⁄2 Perforated Sheet (367-5297)���������������������� 500 per Pkg. D. 1⁄4 Perforated Sheet (367-5298)���������������������� 500 per Pkg. 2 Pkg.@ E. Full Sheet with Color-Changing Ink (367-6658)���������������������� 500 per Pkg. 2 Pkg.@ 92.99 86.99 le with 92.99 86.99 Compatib E * All products featured above are NOT for use in states that require state-approved prescription blanks. For our complete offering of Dental Procedure Coding Books California CALIFORNIA STATE-APPROVED LASER PRESCRIPTION PERSONALIZED FORM * Form complies with state-mandated personalization requirements * Paper size: 81⁄2 " W x 11 " H Full Sheet with Detachable Top-Left Script California (368-1734) ����������������������������������������������������������1000 per Box 2 Boxes @ 152 232.99 209.99 To order, visit: www.henryscheindental.com See page 139