Eagle Creek Printing   CALL US TODAY
772-223-5373
 
Florida Dept of Health  

Florida Prescription Pads | RX Paper
Claim Forms | Envelopes | Software

  AHCA  

SINGLE ENTRY RX PAD
4.25″ X 5.5"
CARBONLESS (2-PART)

>>White Original for Office
>>Yellow Copy For Patient


Click Here for Prices or To Order by Fax or Email

To Order Online Please Fill Out All Information Below:

Contact Information *

If you are a returning customer

Practitioner Information *

Only if printed on script

Misc. Information:

For Security *

Number Of Pads *

Price includes tax and shipping

Verification Image:
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Image Text:
Type the text in the "Verification Image".

Our Security Features
Incorporated Prescription Security Features
  • Front of Original Script must have Blue Background
  • Alterations by Solvents will discolor Blue Pantograph
  • The word “VOID” will appear from Pantograph if copied or faxed
  • Blue Pantograph Background is resistant to Erasures and Alterations
  • Security prescription WATERMARK on back in COIN REACTIVE INK.
  • MICROPRINTING - under magnification, the border on the back of this document should read “EAGLE CREEK SECURITY PRESCRIPTION PAPER”
  • Name and Phone of Florida Approved Vendor at top
  • Security Features explanation box
  • THERMOCHROMIC INK - Rx image on this document fades from red to clear when heat is applied

 

Rapid SSL Security Seal

 Eagle Creek Printing, Inc. | 905 SE Hillcrest Ave. Stuart, Florida 34994

Phone: 772.223.5373 | Fax: 772.223.8993 | www.eaglecreekprinting.com

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