Laser Prescription Forms A J K M L State-Approved Laser Prescription Blank Forms * Forms comply with the most current individual state regulations * All papers meet "tamper-resistant" Medicaid requirements effective October 2008 * Paper size: 81⁄2"W x 11"H A Alaska Full Sheet with Detachable Top-Left Script (367-5867) 500 per Pkg 2 Pkg@ B Delaware Full Sheet (368-0184) 1000 per Pkg 2 Pkg@ C Florida Full Sheet (367-7818) 1000 per Pkg 2 Pkg@ D Florida Full Sheet with Detachable Top-Left Script (367-7821) 1000 per Pkg 2 Pkg@ E Florida 1⁄2 Perforated Sheet (367-7819) 1000 per Pkg 2 Pkg@ F Florida 1⁄4 Perforated Sheet (367-7820) 1000 per Pkg 2 Pkg@ G Georgia Full Sheet (367-7862) 500 per Pkg 2 Pkg@ I H G E 70.29 66.29 200.99 190.99 225.99 215.99 225.99 215.99 220.99 210.99 220.99 210.99 85.99 80.99 PHARMACEUTICALS F D C B N H Indiana Full Sheet with Detachable Top-Left Script (367-5294) 500 per Pkg 2 Pkg@ I Kentucky Full Sheet with Detachable Top-Left Script (367-5861) 500 per Pkg 2 Pkg@ J Maine Full Sheet with Detachable Top-Left Script (367-5296) 500 per Pkg 2 Pkg@ K Washington State Full Sheet (367-7298) 500 per Pkg 2 Pkg@ L Washington State Full Sheet with Detachable Top-Left Script (367-7300) 500 per Pkg 2 Pkg@ M Washington State 1⁄2 Perforated Sheet (367-7295) 500 per Pkg 2 Pkg@ N Washington State 1⁄4 Perforated Sheet (367-7299) 500 per Pkg 2 Pkg@ 85.99 80.99 85.99 80.99 160.99 150.99 85.99 80.99 85.99 80.99 85.99 81.99 70.29 66.29 * All products featured here are NOT for use in other states. Call To Order: 800.372.4346 8:00am-8:30pm (ET) 893http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675294%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675867%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675861%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3680184%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675296%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677818%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677298%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677821%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677300%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677819%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677295%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677820%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677299%26CatalogName%3DDENTAL http://www.henryschein.com/redirect.aspx?did=dental&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677862%26CatalogName%3DDENTAL