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Get SAMPLE ONLY ACTUAL FORMS WILL VARY - Pharmacy Ca

These are 24-hour acute care hospitals, skilled nursing facilities, etc. The forms are preprinted with the facility and the facility s designated prescriber information as indicated below. The actual prescriber information will be printed, handwritten, or stamped on the form when the prescription is written. VOID APPEARS WHEN COPIED REVERSE RX CA WATERMARK MICROPRINT SIGNATURE LINE Institution s State License Number 9999999-0001 Institution Name Address City, State Zip Designated.

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