Rx Pads Guide By State

Florida Administrative Code 64B-3.005 https://www.flrules.org/Gateway/View_notice.asp?id=5762496 HB21 Rule https://www.flhealthsource.gov/FloridaTakeControl/ Medicaid Agency section 409.912 (8)(a)(5) of the Florida Statute http://www.fdhc.state.fl.us/medicaid/prescribed_drug/prescription_pad.shtml ITEM #’S: PRES-1BLH (1 part blue horizontal pad) PRES-1BLV (1 part blue vertical pad) PRES-1GNH (1 part green horizontal pad) PRES-1GNV (1 part green vertical pad) PRES-2BLH (2 part blue horizontal book) PRES-2BLV (2 part blue vertical book) PRES-2GNH (2 part green horizontal book) PRES-2GNV (2 part green vertical book) PRESLBLI (8-1/2”x11” blue laser Rx full sheet, imprinted) PRESLBL2I (8-1/2”x11” blue laser Rx half sheet, imprinted, perfed at 5-1/2” from top) PRESLBL4I (8-1/2”x11” blue laser Rx quarter sheet, imprinted, perfed at 4” from left and 5-1/2” from top) PRESLGNI (8-1/2”x11” green laser Rx full sheet, imprinted) PRESLGN2I (8-1/2”x11” green laser Rx half sheet, imprinted, perfed at 5-1/2” from top) PRESLGN4I (8-1/2”x11” green laser Rx quarter sheet, imprinted, perfed at 4” from left & 5-1/2” from top) FLORIDA RX PADS (cont.)

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