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Schedule III, IV, & V Physician Telephone Orders

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1 – 4$108.35
5 – 9$94.60
10 – 14$80.75
15 +$67.10
SKU: 986P

Stay compliant with forms from the name you trust!

Our new form meets the requirements now being enforced by the DEA. These regulations concern the Schedule III, IV, and V drug classes. Nurses will have to provide documentation stating they are acting as an agent of the physician.

  • 3 part form with 2 detachable orders per sheet
  • Part 3 is chart control copy and mount sheet in one
  • Original order once signed is attached to part 3 using the pressure sensitive tape
  • 125 forms per box

Color:White, Pink, Canary with Black and Red Ink
Size:8-1/2" x 10-1/2" (Parts 1 & 2), 8-1/2" x 11-1/4" (Part 3)
Hole Punch:5 holes on top and left side (Part 3)
Printed:1 sided all printed differently
Quantity:125 ea/bx (Also sold in a case of 8 bx/ca)

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