Micro Format is a Delaware State approved
manufacturer for Rx Paper Products

Quick Reference Guide ~ General Information

Beginning March 1, 2012, ALL written prescriptions must be on tamper-resistant security prescription forms printed by a vendor registered with the Division of Professional Regulation. The forms must contain specific security features (16 Del. C. §4797 (c)). Because there is no single format, pharmacists and prescribers need to be aware of the required security features.

Description of Security Features and Form Requirements

Prescription forms will be required for each practitioner, group practice or institution. The printing on each form must include name, street, city, state, zip code, telephone number, and the prescriber´s Delaware professional license/registration number. Computer software can print the actual prescriber´s/institution´s name and other required information.

• Repetitive Void Pattern - The word "VOID" must appear in a pattern across the entire face of the prescription form when it is scanned, photocopied or faxed.
• Watermark - A printed watermark consisting of the words "Delaware Security Prescription," which is visible to the human eye at a 45-degree angle, must be printed on the back of the prescription blank.
• Coin Reactive Ink - The words "Delaware Security Prescription" must appear on the back of the prescription when rubbed with a coin.
• Chemical Void - To prevent alteration by chemical washing, this feature causes a "VOID" pattern to appear when any area of the form is exposed to ink solvent (i.e., acetone).
• Thermochromic Ink Feature - The back of the prescription must contain a friction-activated ink feature (e.g., RX) in several locations that will disappear or change color when rubbed. It should return to its original color when cooled.
• Solid-Colored Background
• Security Back Print - The back of the prescription must include a chart listing all of the security features.
• Signature Lines -Two signature lines must be printed at the bottom of the face of the form. Under the first line, the words "Substitution Permissible" must be printed. Under the second line, the phrase "In order for a brand name product to be dispensed, the prescriber must hand write Brand Necessary or Brand Medically Necessary in the space provided" (24 Del.C §549).
• Refill Indicator
• Controlled Substance - Only one controlled substance may be listed on each prescription form. The quantity must be written in both number and text format (e.g., #35 (thirty-five)).Serial Numbers - A unique serial number must be printed on each form. No two forms may have the same serial number. Forms for Authorized Institutional Providers.
• Black Light Security - Delaware Security Artificial Watermark on reverse side of prescription will appear fluorescent green when viewed under black light
  

Institutions such as hospitals may register with the Division of Professional Regulation (DPR) to purchase prescription forms on behalf of their licensed practitioners with prescriptive authority. (See Application for Authorization to Purchase Tamper-Resistant Prescription Forms as an Institutional Provider.) If the prescriber´s name is not preprinted on a form purchased by the institution, the form must provide a blank area for the actual prescriber to write, stamp, print his or her name, license number and federal controlled substance registration number (when applicable). Physician´s Assistants ~ Prescriptions must include printed or legible handwritten names of both the licensed Physician´s Assistant and his/her supervising physician as explained in 24 Del. C §1770A and §1771.