CA --- DE --- FL ---GA--- High Security---IN ---KY ---ME --- NJ ---Tamper Resistant ---WA--- WV---WY
click on a state above to go directly to that pad 

CALIFORNIA PRESCRIPTION FORMS - Click here for an approved distributor list.
Must be used for all Level ll thru Level V prescriptions in CA. Imprinted with black ink, second part not printed. Includes all the security features as required by the State of California.

   Padded Style available in 1 or 2 part                                   Laser Style

California


DELAWARE STANDARD PRESCRIPTION FORMS    Click here for an approved distributor list.    (back to top)
Must be used for all Delaware prescriptions.

   Padded Style available in 1 or 2 part  Horizontial                               Portrait

Delaware standard

DELAWARE LASER PRESCRIPTION FORMS    Click here for an approved distributor list.    (back to top)
Must be used for all Delaware prescriptions.

     PRES1L-DE                                                                        PRES4L-DE

Delawar Laser

FLORIDA PRESCRIPTION FORMS - Click here for an approved distributor list.    (back to top)
Must be used for all Medicaid prescriptions in Florida. Imprinted with black ink, second part not printed. Includes all security features required by State of Florida
.

   Padded Style available in 1 or 2 part                                   Laser Style

Florida

GEORGIA PRESCRIPTION FORMS - Click here for an approved distributor list.    (back to top)
Must be used for all Level II prescriptions. Meets all Medicaid prescription requirements in Georgia. Imprinted with black ink, second part not printed. Includes all security features required by State of Georgia
.

   Padded Style available in 1 or 2 part                                   Laser Style

Georgia

HIGH SECURITY PRESCRIPTION FORMS    (back to top)
Can be used for all Level ll thru Level V prescriptions for Medicaid Patients starting October 1st, 2007. Imprinted with black ink, second part imprinted. Includes all the security features required by Medicaid. Contact us for specific information on requirements for your state.

   Padded Style available in 1 or 2 part                                   Laser Style

High Security

INDIANA PRESCRIPTION FORMS    (back to top)
Must be used for narcotic drugs in Indiana. Imprinted in reflex blue, both parts printed the same. Includes all security features required by State of Indiana, duplicate copy printed on second part.

   Padded Style available in 1 or 2 part                                   Laser Style

Indiana

KENTUCKY PRESCRIPTION FORMS    (back to top)
Must be used for all narcotic drugs in Kentucky. Printed with void pantograph on face, standard layout, green ink for base copy and black ink for imprinted information.

   Padded Style available in 1 or 2 part                                   Laser Style

Kentucky

MAINE PRESCRIPTION FORMS    (back to top)
Must be used for all
narcotic drugs in Maine. Imprinted in black ink, second part not printed. Includes all security features as required by the State of Maine.

   Padded Style available in 1 or 2 part                                   Laser Style

Maine

NEW JERSEY PRESCRIPTION FORMS - Click here for an approved distributor list.    (back to top)
Must be used for all prescriptions filled in New Jersey. Imprinted in black ink, Seven different formats, second part not printed. Includes all security features as required by the State of New Jersey.

   Padded Style available in 1 or 2 part                                   Laser Style


New Jersey_2014

TAMPER RESISTANT PRESCRIPTION FORMS - Click here for an approved distributor list.    (back to top)
Must be used for all Level ll thru Level V prescriptions for Medicaid Patients starting October 1st, 2007. Imprinted with black ink, second part not printed. Includes all the security features required by Medicaid. Contact us for specific information on requirements for your state.

   Padded Style available in 1 or 2 part                                   Laser Style

Tamper Resistant

WASHINGTON PRESCRIPTION FORMS - Click here for an approved distributor list.    (back to top)
Must be used for all Prescriptions starting July 1st, 2010.
Imprinted with black ink.

   Padded Style available in 1 or 2 part                                   Laser Style

Washington

WEST VIRGINIA PRESCRIPTION FORMS    (back to top)
Suggested but not required for all narcotic drugs in West Virginia. Imprinted with black ink, second part not printed. Includes all security features as required by the state of West Virginia.

   Padded Style available in 1 or 2 part                                   Laser Style

West Virginia

WYOMING PRESCRIPTION FORMS - Click here for an approved distributor list.     (back to top)
Must be used for all Level ll thru Level V prescriptions in Wyoming. Imprinted with black ink, second part not printed. Includes all the security features as required by the Wyoming.

   Padded Style available in 1 or 2 part                                   Laser Style
Wyoming