PHARMACEUTICALS LASER PRESCRIPTION FORMS A B C D E F G H 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 * For other state-approved forms visit henryscheindental.com A. Florida Full Sheet (367-7818)..................................................... 1000 per Pkg. 2 Pkg.@ B. Florida Full Sheet with Detachable Top-Left Script (367-7821)..................................................... 1000 per Pkg. 2 Pkg.@ C. Georgia Full Sheet (367-7862)....................................................... 500 per Pkg. 2 Pkg.@ D. Indiana Full Sheet with Detachable Top-Left Script (367-5294)....................................................... 500 per Pkg. 2 Pkg.@ * All products featured here are NOT for use in other states. E. Kentucky Full Sheet with Detachable Top-Left Script (367-5861)....................................................... 500 per Pkg. 2 Pkg.@ F. Washington State Full Sheet (367-7298)....................................................... 500 per Pkg. 2 Pkg.@ G. Washington State Full Sheet with Detachable Top-Left Script (367-7300)....................................................... 500 per Pkg. 2 Pkg.@ H. Washington State 1 ⁄4 Perforated Sheet (367-7299)....................................................... 500 per Pkg. 2 Pkg.@ 974 To order, visit: www.henryscheindental.com Compatible with Compatible with Compatible with Compatible with Compatible with Compatible with Compatible withhttp://www.henryscheindental.com 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%3Dmerchandise20212022-sm-nopricing%26utm_term%3D3677818 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%3Dmerchandise20212022-sm-nopricing%26utm_term%3D3675861 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%3Dmerchandise20212022-sm-nopricing%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%3Dmerchandise20212022-sm-nopricing%26utm_term%3D3677821 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%3Dmerchandise20212022-sm-nopricing%26utm_term%3D3677862 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%3Dmerchandise20212022-sm-nopricing%26utm_term%3D3677300 http://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%3Dmerchandise20212022-sm-nopricing%26utm_term%3D3675294 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%3Dmerchandise20212022-sm-nopricing%26utm_term%3D3677299 http://www.henryscheindental.com