Laser Prescription Forms PHARMACEUTICALS D E Compatib le with I Compatib le with Compatib M Compatib le with Compatib le with Compatib le with N le with STATE-APPROVED LASER PRESCRIPTIONÂ 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.@ 200.99 190.99 C. Florida Full Sheet (367-7818) ..................................................................................1000 per Pkg. 2 Pkg.@ 224.99 214.99 70.29 66.29 D. Florida Full Sheet with Detachable Top-Left Script (367-7821) ..................................................................................1000 per Pkg. 2 Pkg.@ 220.99 210.99 E. Florida / 2 Perforated Sheet (367-7819) ..................................................................................1000 per Pkg. 2 Pkg.@ 220.99 210.99 F. Florida 1/ 4 Perforated Sheet (367-7820) ..................................................................................1000 per Pkg. 2 Pkg.@ 220.99 210.99 G. Georgia Full Sheet (367-7862) ....................................................................................500 per Pkg. 2 Pkg.@ 84.99 79.99 1 904 www.henryscheindental.com H. Indiana Full Sheet with Detachable Top-Left Script (367-5294) ....................................................................................500 per Pkg. 2 Pkg.@ 84.99 79.99 I. Kentucky Full Sheet with Detachable Top-Left Script (367-5861) ....................................................................................500 per Pkg. 2 Pkg.@ 84.99 74.99 J. Maine Full Sheet with Detachable Top-Left Script (367-5296) ....................................................................................500 per Pkg. 2 Pkg.@ 160.99 150.99 K. Washington State Full Sheet (367-7298) ....................................................................................500 per Pkg. 2 Pkg.@ 84.99 79.99 L. Washington State Full Sheet with Detachable Top-Left Script (367-7300) ....................................................................................500 per Pkg. 2 Boxes @ 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.@ * All products featured here are NOT for use in other states. 70.29 66.29 85.99 81.99 70.29 66.29http://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 http://www.henryscheindental.com