LASER PRESCRIPTION FORMS E I C B F J 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 Florida Full Sheet (367-7818) 1000 per Pkg 2 Pkg@ C Florida Full Sheet with Detachable Top-Left Script (367-7821) 1000 per Pkg 2 Pkg@ D Florida 1⁄2 Perforated Sheet (367-7819) 1000 per Pkg 2 Pkg@ E Florida 1⁄4 Perforated Sheet (367-7820) 1000 per Pkg 2 Pkg@ F Georgia Full Sheet (367-7862) 500 per Pkg 2 Pkg@ 75.99 71.29 226.99 216.99 226.99 216.99 220.99 210.99 220.99 210.99 92.99 86.99 D G H K L G Indiana Full Sheet with Detachable Top-Left Script (367-5294) 500 per Pkg 2 Pkg@ H Kentucky Full Sheet with Detachable Top-Left Script (367-5861) 500 per Pkg 2 Pkg@ I Washington State Full Sheet (367-7298) 500 per Pkg 2 Pkg@ J Washington State Full Sheet with Detachable Top-Left Script (367-7300) 500 per Pkg 2 Pkg@ K Washington State 1⁄2 Perforated Sheet (367-7295) 500 per Pkg 2 Pkg@ L Washington State 1⁄4 Perforated Sheet (367-7299) 500 per Pkg 2 Pkg@ PHARMACEUTICALS A 92.99 86.99 92.99 86.99 92.99 86.99 92.99 86.99 93.99 87.99 75.99 71.29 * All products featured here are NOT for use in other states. Call to Order: 800.372.4346 8:00am-8:30pm (ET) 907http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675294%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3675294 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675867%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3675867 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3675861%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3675861 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677818%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3677818 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677298%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3677298 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677821%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3677821 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677300%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3677300 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677819%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3677819 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677295%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3677295 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677820%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3677820 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677299%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3677299 http://www.henryschein.com/redirect.aspx?did=specialmarkets_m&returnurl=/us-en/Shopping/ProductDetails.aspx%3Fproductid%3D3677862%26CatalogName%3DPRIME%26utm_source%3DSpecialMarkets%26utm_medium%3DNxtbook%26utm_campaign%3Dmerchandise2019-v2%26utm_term%3D3677862