www.CaliforniaRxPaper.com
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  • TAMPER RESISTANT
    LASER
    California Rx Prescription
    INSTITUTION style controlled substance prescription forms

    California laser Rx Paper

    Custom Imprinted
    for use in the State of California


    For a California Medical FACILITY to qualify as a
    LICENSED HEALTH CARE FACILITY so you can order INSTITUTION style controlled substance prescription forms --
    it must be a licensed facility pursuant to Article 1 (commencing with section 1250) of Chapter 2 of Division 2
    of the California Health and Safety Code.

    Article 1 Section 1250


    Micro Format, Inc. is a California State approved provider for Rx Paper Products. As such, we are obligated by law to insure only those qualified
    can purchase medical prescription paper for use in the State of California.
    For us to manufacture INSTITUTION STYLE controlled substance prescriptions forms, we require an affidavit be signed attesting to the fact you have read
    Article 1 Section 1250 of Chapter 2 of Division 2 of the California Health and Safety Code
    and that your health care facility meets the necessary requirements.

    Should a question arise, Micro Format will present this signed document to any authorized California State Official and aid in any on going investigation.


    I attest to the fact I have read Article 1 Section 1250
    of Chapter 2 of Division 2 of the California Health and Safety Code
    and that the health care facility listed below meets the necessary facility requirements.
    I further state that I am authorized to sign this statement.

    Date:
    Your Name:
    Your Title:
    Facility Name:
    Address:
    City:
    State: ZIP:
    Daytime Phone:
    E-Mail:

    Please place comments in the space below. Thank you.


    Return to
    California Laser Rx Paper Web Page


    Copyright © 2013- Micro Format, Inc., All Rights Reserved
    Micro Format, Inc.
    830-3 Seton Court ~ Wheeling, IL 60090
    Phone: 847/520-4699 ~ 800-333-0549
    Fax 847/520-0197


    rev 1/2016