Categories: Clinical Forms : Prescription Blanks
070292789_1D

Washington State Prescription Blanks – 2 Part, Second Part Blank, 5-1/2" W x 4-1/4" H, 100 Sets/Pad, 10 Pads/Pkg

Patterson Office Supplies
Patterson Item #: 70292797
Mfg Item #: VJO-PTC16-PAT3
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Specifications

# of Parts:
2 part
Design Color:
Gray
Dimensions:
5-1/2" W x 4-1/4" H
Ink Color:
Black
Logo:
N
Manufacturer Name:
PATTERSON OFFICE SUPPLIES
Material:
Two-Part Carbonless stock; First part – 26 lb white security paper CB, Second Part – 20 lb yellow CF
Package Quantity:
100 Sets/Pad; 10 Pads/Pkg
Product Color:
White
Security Features:
  • The State of Washington requires the state seal be printed on every prescription form. This seal is made up of the state of Washingtion printed in green to yellow thermochromatic ink. The seal appears green until heat or friction is applied then the color changes to yellow. Also built into the seal is an image of a mortar and pestle which is printed as a gray watermark.
  • Void Pantograph – The word "Void" appears when document is photocopied
  • Security features listed on face
  • 2 signature lines – one for "Dispense as written" and one for "Substitution permitted"
  • Quantity check off boxes (optional)
  • Paper has a chemical coating which reacts with bleach or eradication solutions to prevent forgers from altering written copy. If bleach is applied to a sheet the paper turns brown or a chemical void feature appears to make prescription form unusable.
  • Security Prescription" watermark printed on back
  • Microprint signature lines
  • A choice of either " Prescription is void if more than one controlled substance prescription is written per blank" or "___ Prescription is void if the number of drugs prescribed is not noted". This feature keeps patients from adding an additional prescription to a prescription form after it has been written by a physician.

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MSDS / SDS
List 1
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