Catalog

Volume 2

Integral Solutions

Supplies Catalog

Company Profile

Since 1985, Integral Solutions Group has been a single source solution for business essentials
and network supplies. We provide the highest grade materials for reliability and superior quality over
low cost solutions. Utilizing our 40,000 square foot facility, we offer a wide variety of stock products
with support staff to ship orders the same day, and we focus on designing, developing and producing
customized product solutions to meet your needs. ISG provides the critical link between your software
system and business essentials. We support pharmacies, hospitals, long term care facilities, HME
businesses and governmental agencies.

ISG specializes in laser, dual-web combinations, paper, pressure sensitive and thermal labels. We
provide laser, continuous, multi-part, snap-out and pressure seal forms. Our product line encompasses
prescription labels, prescription packaging, forms, bags, vials, envelopes, printer supplies, POS products
and much more. We supply products that will work with any pharmacy software and automated
dispensing systems. We are dedicated to being an integral part of your business.

www.integralsupplies.com

Table of Contents 

Pharmacy Labels 1 
5 
Thermal 7 
ScriptChek 11 
Laser 13
Dot Matrix 14 
Automated Dispensing System (ADS) 
Custom 

Pharmacy Bags 15
16
Custom 17
Stock
HangUp Retrieval Bags

Prescription Pad Supplies 19
20
Stock Pads, Folders, Storage Boxes
Custom Pads

Vials and Ovals 21
22
Vials
Vials and Ovals

Prescription Packaging 23
25
Cold Seal Cards 27
Heat Seal Cards 28
Blisters 29
Multi-Dose 30
Unit Dose 31
Packaging Equipment
Heat Sealers

Long Term Care Forms 32
33
Ring Binders 35
Physician Orders 37
Medication Records 38
Treatment Records
Personal Care / Antipsychotic

Statements and Envelopes 39
40
Statements
Envelopes and Folding Machines

Printer Supplies 41
41
Register Rolls / POS 42
Shelf Labels / Price Stickers 43
Ribbons
Toner

Items noted with “Stock #” or “In Stock” are available for same day shipping on orders entered by 3pm EST.

Thermal Pharmacy Labels

Thermal labels are available in direct thermal and thermal transfer material.
We supply labels that have been extensively tested to withstand fading from UV and sunlight exposure.
Our labels are compatible with any software application and below are examples of our popular styles.

CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed. CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed. CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.

(LO) G31 THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE. THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.
2” X 4 1/2”
(ZA) M9473 M8428
4” X 4 1/2” 4” X 7 7/8”

CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed. CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.Best Seller

THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE. THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.

M8423 (ZB) M8510
4” X 7 7/8” 4” X 7 7/8”

PATIENT CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.
COUNSELING
THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.
I HAVE READ AND AGREE TO THE RELEASE STATEMENT BELOW.
X M9520
SIGNATURE 4” X 4 1/2”

THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE. www.integralsupplies.com

CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed. THE ABOVE SIGNED CERTIFIES: (A) THAT THE PERSON FOR WHOM THE PRESCRIPTION WAS WRITTEN IS
ELIGIBLE FOR BENEFITS; (B) THAT THEY HAVE RECEIVED THE PRESCRIPTION LISTED; (C) THAT THEY
AUTHORIZE RELEASE OF ALL INFORMATION CONTAINED ON THIS LOG, THE PRESCRIPTION TO WHICH IT
CORRESPONDS AND SUBSEQUENT CLAIM TO PARTIES CONCERNED; (D) THAT THEY ARE THE PATIENT
FOR WHOM THIS PRESCRIPTION IS BEING OBTAINED OR ARE AUTHORIZED TO EXECUTE THIS CONSENT
ON BEHALF OF SUCH PERSON; (E) THAT THIS MEDICATION IS NOT FOR AN ON-THE-JOB INJURY OR
COVERED BY ANY OTHER INSURANCE PLAN; AND (F) THAT THEY ASSIGN PAYMENT FOR THIS
TRANSACTION DIRECTLY TO THE MEMBER PHARMACY SHOWN ABOVE.

EXP. Written information about this prescription has been provided for you. Please read this information before you take the medication.
DATE If you have questions concerning this prescription, a pharmacist is available during normal business hours to answer thes questions.
Lehan dado informacion pro escrito sobre esta receta. Por favor lea esta informacion antes de tomar la medicina. Si Usted tiene

preguntas tocante esta receta un farmaceutico esta disponible para contestar sus preguntas durante las horas de trabejo.

M1436
4” X 10 3/4”

 Shop more at integralsupplies.com/store/thermal

Thermal Pharmacy Labels

CAUTION: Federal law prohibits the transfer of this drug to any person other than the patient for whom prescribed.
REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767

REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767

(Z2) M8610 M8640
3 1/8” X 8 1/2” 4" X 8 1/2" 4" X 8 1/2"

Call your doctor for medical advice about side effects. CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.
You may report side effects to FDA at 1-800-FDA-1088.
CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.

CUSTOMER RECEIPT

M8428 M2495
4” X 7 3/4” 3 11/16” X 3 15/16”

X PATIENT Rx
COUNSELING
CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.
I HAVE READ AND AGREE TO THE RELEASE STATEMENT BELOW.
X
SIGNATURE

THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.

CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed. RECEIPT

EXP. THE ABOVE SIGNED CERTIFIES: (A) THAT THE PERSON FOR WHOM THE PRESCRIPTION WAS WRITTEN IS Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
DATE ELIGIBLE FOR BENEFITS; (B) THAT THEY HAVE RECEIVED THE PRESCRIPTION LISTED; (C) THAT THEY
AUTHORIZE RELEASE OF ALL INFORMATION CONTAINED ON THIS LOG, THE PRESCRIPTION TO WHICH IT M9512
M1406 CORRESPONDS AND SUBSEQUENT CLAIM TO PARTIES CONCERNED; (D) THAT THEY ARE THE PATIENT 4” X 4 1/2”
4” X 10 3/4” FOR WHOM THIS PRESCRIPTION IS BEING OBTAINED OR ARE AUTHORIZED TO EXECUTE THIS CONSENT
ON BEHALF OF SUCH PERSON; (E) THAT THIS MEDICATION IS NOT FOR AN ON-THE-JOB INJURY OR
COVERED BY ANY OTHER INSURANCE PLAN; AND (F) THAT THEY ASSIGN PAYMENT FOR THIS
TRANSACTION DIRECTLY TO THE MEMBER PHARMACY SHOWN ABOVE.

Written information about this prescription has been provided for you. Please read this information before you take the medication.
If you have questions concerning this prescription, a pharmacist is available during normal business hours to answer thes questions.

Lehan dado informacion pro escrito sobre esta receta. Por favor lea esta informacion antes de tomar la medicina. Si Usted tiene
preguntas tocante esta receta un farmaceutico esta disponible para contestar sus preguntas durante las horas de trabejo.

800.235.0767 Shop more at integralsupplies.com/store/thermal 

Thermal Pharmacy Labels

REORDER

CAUTION: Federal law prohibits the transfer of this drug to any person other than patient for whom prescribed.

M9444 CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed. Please pull tag and a x to re ll order
3 11/16” X 2 7/8” form when reorder point is reached.
M0437
3” X 2 5/16” M0515
3 1/4” X 4 14/16”

REORDER CAUTION: Federal law prohibits the transfer of this drug
to any person other than the patient for whom prescribed.
CAUTION: Federal law prohibits the transfer of this drug to any person other than patient for whom prescribed.

REORDER

M9468 M8526
3 13/16” X 2 1/8” 3 11/16” X 2 3/4”

M2421
3 11/16” X 3 7/8”

CAUTION: Federal law prohibits the transfer of this drug to any REORDER CAUTION: Federal law prohibits the transfer of this drug to any person other than patient for whom prescribed.
person other than the patient for whom it was prescribed.
M0609
M0489 3 7/8” X 1 27/32” M9438
4 7/8” X 2 1/4” 2 3/4” X 2 5/32”

 Shop more at integralsupplies.com/thermal www.integralsupplies.com

Thermal Pharmacy Labels M4432 CAUTION: Federal law prohibits the transfer of this drug to any M0519 REORDER M8400 Shop more at integralsupplies.com/store/thermal 
1 1/2” X 3 3/8” person other than the patient for whom it was prescribed. 2 15/16” X 1 7/8” 3 11/16” X 3 5/8”
CAUTION: Federal law prohibits the transfer of this drug
Call your doctor for medical advice about side effects. to any person other than patient for whom prescribed.
You may report side effects to FDA at 1-800-FDA-1088.

REORDER (ZN) E26 M8442 (ZT) M9511
3 11/16” X 3 7/8” 2 3/4” X 2 3/4” 3 7/8” X 4”
CAUTION: Federal law prohibits the transfer of this drug to any person other than patient for whom prescribed.

Best Seller (LN) C7 (ZE) M1441 M8407
3 11/16” X 2 3/4” 2 3/8” X 2 5/8” 4” X 3 7/8”

800.235.0767

CAUTION: Federal law prohibits transfer of this drug
to any person other than patient for whom prescribed.

CAUTION: Federal law prohibits the transfer of this drug to any person other than patient for whom prescribed.
Do not use with alcohol or nonprescription drugs without consulting prescriber.

ScriptChek Pharmacy Labels

The ScriptChek Label Design Gives You
90% More Space For Important
Prescription Information.

Federal Caution Statement Description of Medicine
Patient Counseling Warning
Prescription Information
Barcode

QR Barcode

Insurance Information

Vertical and Horizontal
Drug Name

Customers Scan the QR Barcode to Refill Prescriptions.

The ScriptChek® patented extended tab label provides the space you need for important
prescription drug information.

ScriptChek® Extended Tab label design is protected by US Patent No. 7,398,999 and 7,926,851 and other US and International Patents Pending. ScriptChek® is a Registered Trademark of the J M Smith Corporation.

 Shop more at integralsupplies.com/store/scriptchek www.integralsupplies.com

ScriptChek Pharmacy Labels

Do you need more space on your prescription labels?
The solution is our patented ScriptChek® label. The prescription label has
a tab that extends off of the vial allowing you to add additional information
to the front and back of the tab.

Best Seller ScriptChek R Extended Label design is protected by U.S. Patent Nos. 7,398,999 and 7,926,851, and other U.S. and International Patents Pending

ScriptChek R Extended Label design is protected by U.S. Patent Nos. 7,398,999 and 7,926,851, and other U.S. and International Patents Pending

REORDER FROM: INTEGRAL SOLUTIONS GROUP 1-800-235-0767 REORDER FROM: INTEGRAL SOLUTIONS GROUP 1-800-235-0767

(SZ) M8418 M8415 Front
4” X 8 1/2” 4” X 8 1/2” •• Warning Information
• Description of Medicine
ScriptChek R Extended Label design is protected by U.S. Patent Nos. 7,398,999 and 7,926,851, and other U.S. and International Patents Pending ScriptChekR Extended Label design is protected by U.S. Patent Nos. 7,398,999 and 7,926,851, and other U.S. and International Patents Pending Insurance Information
REORDER FROM: INTEGRAL SOLUTIONS GROUP 1-800-235-0767 LABEL SM REORDER FROM: INTEGRAL SOLUTIONS GROUP 1-800-235-0767 LABEL SN

(SN) M8420 Back
(8 1/2” X 9” ••• Patient Counseling
(SM) M8416 Prescription Barcode
8 1/2” X 13” ScriptChek R Extended Label design is protected by U.S. Patent Nos. 7,398,999 and 7,926,851, and other U.S. and International Patents Pending QR Barcode for Refills
IMPORTANT: INFORMATION ABOUT YOUR MEDICATION
ScriptChek R Extended Label design is protected by U.S. Patent Nos. 7,398,999 and 7,926,851, and other U.S. and International Patents Pending CAUTION: Federal law prohibits the transfer of this drug to any ScriptChek R Extended Label design is protected by U.S. Patent Nos. 7,398,999 and 7,926,851, and other U.S. and International Patents Pending
person other than the patient for whom it was prescribed. REORDER FROM: INTEGRAL SOLUTIONS GROUP 1-800-235-0767

CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.

IMPORTANT: INFORMATION ABOUT YOUR MEDICATION

THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.

DISP PHARMACIST Rx No.
TELEPHONED
DATE-
NDC CLASS TRANS-
DR.
SIG QTY-
UNIT-
SUBSTITUTION PERMITTED DISP-
DISPENSE AS WRITTEN
DAYS SUPPLY
DEA NBR.
WEL NBR.
STATE LICENSE

(SP) M8555
8 1/2” X 9”

(SX) M8556 M8411
8 1/2” X 13” 8 1/2” X 11”

800.235.0767 Shop more at integralsupplies.com/store/scriptchek 

Laser Pharmacy Labels

“Manufactured to exceed industry standards for laser printers.” REORDER FROM: INTEGRAL SOLUTIONS GROUP: 1-800-235-0767

REORDER FROM:
INTEGRAL SOLUTIONS GROUP

1-800-235-0767

M8646 M8643 Call your doctor for medical
8 1/2" X 11" 8 1/2" X 11" advice about side e ects.You
m1-a8y0re0p-oFrDt Asid-1e0e8e8c.ts to FDA at

(VIP) M8395
8 1/2" X 11"

REORDER FROM: INTEGRAL SOLUTIONS GROUP REORDER FROM: INTEGRAL SOLUTIONS GROUP “Manufactured to exceed industry standards for laser printers.” REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767 1-800-235-0767 1-800-235-0767
“Manufactured to exceed industry standards for laser printers.” “Manufactured to exceed industry standards for laser printers.”

CAUTION: FEDERAL LAW PROHIBITS THE TRANSFER OF THIS
DRUG TO ANY PERSON OTHER THAN THE PATIENT FOR WHOM
IT WAS PRESCRIBED.

THIRD DECLINED DUR N.S.C.
PARTY PATIENT COUNSELING

Signature

RECEIPT

SAVE FOR INSURANCE
OR TAX RECORDS

RECEIPT

SAVE FOR INSURANCE
OR TAX RECORDS

DUPLICATE

PATIENT COUNSELING

*MONEY SAVING COUPON* *MONEY SAVING COUPON* *MONEY SAVING COUPON* *MONEY SAVING COUPON*

COUPON EXPIRES: *MONEY SAVING COUPON* COUPON EXPIRES: *MONEY SAVING COUPON*
*MONEY SAVING COUPON* *MONEY SAVING COUPON*

COUPON EXPIRES: COUPON EXPIRES:

M8735 M8741 M8660
8 1/2" X 11" 8 1/2" X 11" 8 1/2" X 11"

“Manufactured to exceed industry standards for laser printers.” “Manufactured to exceed industry standards for laser printers.”

REORDER FROM: REORDER FROM: INTEGRAL SOLUTIONS GROUP
INTEGRAL SOLUTIONS GROUP 1-800-235-0767

1-800-235-0767

IMPORTANT: INFORMATION ABOUT YOUR MEDICATION

THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.

DISP PHARMACIST Rx No. DISP PHARMACIST Rx No.
TELEPHONED TELEPHONED
DATE- DATE-
NDC CLASS TRANS- NDC CLASS TRANS-
DR. DR.
SIG QTY- SIG QTY-
UNIT- UNIT-
SUBSTITUTION PERMITTED DISP- SUBSTITUTION PERMITTED DISP-
DISPENSE AS WRITTEN DISPENSE AS WRITTEN
DAYS SUPPLY DAYS SUPPLY
DEA NBR. DEA NBR.
WEL NBR. WEL NBR.
STATE LICENSE STATE LICENSE

M8636 M8665 M8605
8 1/2" X 11" 8 1/2" X 11" 8 1/2" X 11"

 Shop more at integralsupplies.com/store/laser www.integralsupplies.com

Laser Pharmacy Labels

Manufactured by a International "Converter List" registered vendor.

REORDER FROM: Best Seller
INTEGRAL SOLUTIONS GROUP
“Manufactured to exceed industry standards for laser printers.”
1-800-235-0767 LABEL LX
CAUTION: Federal law prohibits transfer of this drug to CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.
any person other than the patient for whom prescribed.

REORDER FROM:
INTEGRAL SOLUTIONS GROUP

1-800-235-0767 LABEL LP

IMPORTANT: INFORMATION ABOUT YOUR MEDICATION

THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE. IMPORTANT: INFORMATION ABOUT YOUR MEDICATION

THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.

DISP PHARMACIST Rx No.
TELEPHONED
DATE-
NDC CLASS TRANS-
DR.
SIG QTY-
UNIT-
SUBSTITUTION PERMITTED DISP-
DISPENSE AS WRITTEN
DAYS SUPPLY
DEA NBR.
WEL NBR.
STATE LICENSE

(LP) M8729
8 1/2" X 9"

“Manufactured to exceed industry standards for laser printers.” (A5) M8666
8 1/2" X 11"

(LX) M8709 REORDER FROM: INTEGRAL SOLUTIONS GROUP
8 1/2" X 13" 1-800-235-0767 LABEL LR

CAUTION: Federal law prohibits the transfer of this drug to any
person other than the patient for whom it was prescribed.

REORDER FROM: INTEGRAL SOLUTIONS GROUP “Manufactured to exceed industry standards for laser printers.”
1-800-235-0767 LABEL H1

(H1) M8602 (LR) M8678 M8701
8 1/2" X 11" 8 1/2" X 14" 8 1/2" X 11"

M8705 “Manufactured to exceed industry standards for laser printers.”
8 1/2" X 11"
REORDER FROM: FEED THIS DIRECTION REORDER FROM: INTEGRAL SOLUTIONS GROUP
800.235.0767 INTEGRAL SOLUTIONS GROUP 1-800-235-0767 1-800-235-0767 LABEL LT

Signature Log CAUTION: Federal law prohibits the transfer of this drug to any
person other than the patient for whom it was prescribed.
Signature

THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.

DISP PHARMACIST Rx No.
TELEPHONED
DATE-
Receipt Receipt NDC CLASS TRANS-
DR.
SIG QTY-
UNIT-
SUBSTITUTION PERMITTED DISP-
DISPENSE AS WRITTEN
DAYS SUPPLY
DEA NBR.
WEL NBR.
STATE LICENSE

(P2) M8570 (LT) M8739
8 1/2" X 11" 8 1/2" X 11"

Shop more at integralsupplies.com/store/laser 

Laser Pharmacy Labels

“Manufactured to exceed industry standards for laser printers.”

REORDER FROM:
INTEGRAL SOLUTIONS GROUP

1-800-235-0767
CAUTION: Federal law prohibits transfer of this drug to
any person other than the patient for whom prescribed.

REORDER FROM:
INTEGRAL SOLUTIONS GROUP

1-800-235-0767
REORDER FROM: SMITH DATA PROCESSING 1-800-235-0767 LABEL STYLE: G8 “Manufactured to exceed industry standards for laser printers.”
THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.
(G8) M8574
8 1/2" X 11" DISP PHARMACIST Rx No.
TELEPHONED
DATE-
NDC CLASS TRANS-
DR.
SIG QTY-
UNIT-
SUBSTITUTION PERMITTED DISP-
DISPENSE AS WRITTEN
DAYS SUPPLY
DEA NBR.
WEL NBR. M8632
STATE LICENSE 8 1/2" X 11"

M8618
8 1/2" X 11"

REORDER FROM: INTEGRAL SOLUTIONS GROUP “Manufactured to exceed industry standards for laser printers.”
1-800-235-0767

M8702 M8624 M8616
8 1/2" X 11" 8 1/2" X 11" 8 1/2" X 11"

“Manufactured to exceed industry standards for laser printers.” (C1) M8577
8 1/2" X 14"
REORDER FROM: INTEGRAL SOLUTIONS GROUP www.integralsupplies.com
1-800-235-0767

THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.

DISP PHARMACIST Rx No.
TELEPHONED
DATE-
NDC CLASS TRANS-
DR.
SIG QTY-
UNIT-
SUBSTITUTION PERMITTED DISP-
DISPENSE AS WRITTEN
DAYS SUPPLY
DEA NBR.
WEL NBR.
STATE LICENSE

M8713 M8619
8 1/2" X 11 " 8 1/2" X 11"

 Shop more at integralsupplies.com/store/laser

Laser Pharmacy Labels

REORDER FROM: INTEGRAL SOLUTIONS GROUP “Manufactured to exceed industry standards for laser printers.”
1-800-235-0767

CAUTION: Federal law prohibits the transfer of this drug to any person other than the patient for whom prescribed.

CAUTION: FEDERAL LAW PROHIBITS THE TRANSFER OF THIS IF YOU DON'T KNOW YOUR DRUGS CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.
DRUG TO ANY PERSON OTHER THAN THE PATIENT FOR WHOM
IT WAS PRESCRIBED. KNOW YOUR PHARMACIST Ask C26
Me 4" X 7 1/2"
REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.IMPORTANT: INFORMATION ABOUT YOUR MEDICATION

Prescription Information

DISP. PHARMACIST Rx No.
TELEPHONED
STATUS

DATE-
TRANS-

NDC QTY-
UNIT-
SIG DISP-

SUBSTITUTION PERMITTED CLASS DAYS SUPPLY
DISPENSE AS WRITTEN DR.
DEA NBR.
WEL. NBR.
STATE LICENSE

M8638 (LZ) SG4
8 1/2" X 14" 8 1/2" X 9"
All Paper
CAUTION: Federal law prohibits the transfer of this drug to any person other than the patient for whom prescribed.
REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767
REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767
REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767
REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767

(RZ) M8640 M8621 M8610 M8588
4" X 8 1/2" 4" X 8 1/2" 4" X 8 1/2" 4" X 8 1/2"

CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed. CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.
REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767

REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767

REORDER FROM: INTEGRAL SOLUTIONS GROUP
1-800-235-0767

C24 B17 C28 C27
4" X 7 1/2" 4" X 7 1/2" 4" X 7 1/2" 4" X 7 1/2"
800.235.0767
Shop more at integralsupplies.com/store/laser 

Dot Matrix Pharmacy Labels

REORDER FROM: INTEGRAL SOLUTIONS GROUP DISP. PHARMACIST Rx No. Best Seller
1-800-235-0767 LABEL JF TELEPHONED STATUS

CAUTION: Federal law prohibits transfer of this drug to THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE. REORDER FROM: INTEGRAL SOLUTIONS GROUP 1-800-235-0767 NDC CLASS DATE-
any person other than the patient for whom prescribed. DR. DR. TRANS-
SIG
(JF) MJFX QTY-
10 1/8” X 4” SUBSTITUTION PERMITTED UNIT-
DISPENSE AS WRITTEN DISP-
PATIENT EDUCATION COUNSELING DEA NBR.
This Specific Information May Or WEL. NBR. DAYS SUPPLY
May Not Apply To Your Condition. STATE LICENSE
Please Consult Your Doctor.
IF YOU DON'T KNOW YOUR DRUGS Ask
KNOW YOUR PHARMACIST Me

B0431

IMPORTANT: INFORMATION ABOUT YOUR MEDICATION

CAUTION: FEDERAL LAW PROHIBITS THE TRANSFER OF THIS THIS IS YOUR RECEIPT. PLEASE RETAIN FOR YOUR TAX OR INSURANCE.
DRUG TO ANY PERSON OTHER THAN THE PATIENT FOR WHOM DR.
IT WAS PRESCRIBED.
YOU CAN PLACE YOUR TRUST IN:

REORDER FROM: INTEGRAL SOLUTIONS GROUP 1-800-845-7558 (N)
9 7/8” X 8 1/2”

All Paper

M0874 M2108
9 1/2” X 5” 5” X 4”

thank you! COUNSELED EASY OPEN NOT THE PATIENT
DECLINED COUNSELING
PATIENT COUNSELING
SIGNATURE OF PATIENT OR LEGAL REPRESENTATIVE

X

CAUTION: FEDERAL LAW PROHIBITS TRANSFER OF THIS DRUG TO ANY PERSON OTHER THAN PATEINT FOR WHOM PRESCRIBED.

N19 M1412
5” X 7” 3 1/2” X 5 1/2”

 Shop more at integralsupplies.com/store/dot-matrix www.integralsupplies.com

Dot Matrix Pharmacy Labels

M2971 M2144 (J) D18
5” X 3” 5” X 1 1/2” 3 1/2” X 2”

1-ply

M2969 D20
7 7/8” X 3” 3 1/2” X 2”

Best Seller M2F73
5” X 1 1/2”
H10 (J) H21
3 3/4” X 1 2/3” 3 1/2” X 2”

2-ply

------------------------------------
------------------------------------

(#3) B13 H24 H26
4” X 2 1/2” 5” X 2” 3 1/2” X 2”

2-ply Shop more at integralsupplies.com/store/dot-matrix 

800.235.0767

Automated Pharmacy Labels

Thermal prescription labels for automated
dispensing systems including RxMedic, Scriptpro
and Parata.

• Products are compatible with all automated
dispensing machines.

• Stock prescription labels are available with
permanent and removable adhesive.

• All products are manufactured with premium
grade material for durability and reliability.

• Stock bin labels are available to identify drawers.
• Choice of 16 standard colors or PMS color match

are available to preprint your store information.

CAUTION: Federal law prohibits transfer of this drug to any person other than patient for whom prescribed.

(ADS) M8507
4” X 2”

 Shop more at integralsupplies.com/custom-products.php Stock # 901090
Bin Labels

www.integralsupplies.com

Custom Pharmacy Labels

Custom labels are a great way
to promote your pharmacy and
establish branding with your
customers.

• No Art or Plate Charge
with Minimum Quantity
Order (Restrictions Apply)

• Free Storage
• Inventory Management
• Art Files Accepted

STANDARD INK COLORS

STANDARD SYMBOLS yellow red
Below are popular symbols you can use on your custom printed labels
or use your own custom logo and special design.

orange burgundy

green maroon

dark green gray

dark blue violet

medium blue gold

light blue pink

black brown

800.235.0767 Shop more at integralsupplies.com/custom-products.php

Pharmacy Bags

Standard bag designs with your name imprinted
Print your logo and store information to meet your specific needs or you can use one of our
standard styles below and add your store information.

Your Name Your Name Your Name

Address Address Address
Phone Number Phone Number Phone Number

Quality Old Time Gold Mortar

Blue & Gold Black & Red Black & Gold
Green & Gold Blue & Red Blue & Gold
Black & Gold Green & Gold

Your Name Your Name Your Name

Address Address Address
Phone Number Phone Number Phone Number

Bronze Weighscale Stripes Medicine & Pill

Blue & Gold Red, Blue or Black & Red
Green & Gold Green Stripes
Name in Black

Your Name

Address
Phone Number

Your Name Your Name

Address Address
Phone Number Phone Number

Showglass Vintage Antique Sign

Blue, Red, Black, Black & Red Blue & Black
Maroon or Green Maroon & Gold

 Shop more at integralsupplies.com/store/custom-products.php www.integralsupplies.com

Pharmacy Bags

STANDARD INK COLORS

Custom Bag Sizes Yellow Red Medium Teal

Prescription Bags with Side Gussets Orange Magenta Forest Green

Stock # Size Qty / Case
605460 #21, 3 1/2 X 1 1/2 X 10 3,000
605461
605471 #22, 4 1/2 X 2 1/4 X 11 3,000
605464
#23, 5 X 2 X 10 3,000 Green - Blue Maroon Light Teal

#15, 8 1/2 X 3 1/2 X 14 1/2 1,000

Flat Counter / Card Bags Dark Green Gray Lime Gold

Stock # Size Qty / Case Dark Blue Purple Dark Teal
605462 #12, 7 X 10 3,000
605463 #14, 9 X 11 2,000

Square Bottom Grocery / Lunch Bags

Stock # Size Qty / Case Medium Blue Gold Tan
605465
605466 #25, 5 3/4 X 3 3/4 X 10 5/8 2,000
605467
#26, 6 1/2 X 4 X 13 1/2 1,000

#28, 8 X 5 X 16 1/2 750 Light Blue Pink Kelly Green

Black Brown

Stock Bag Sizes

Prescription Bags with Side Gussets

Stock # Size Qty / Case
605475
605476 #21, 3 1/2 X 1 1/2 X 10 3,000
605477
605480 #22, 4 1/2 X 2 1/4 X 11 3,000

#23, 5 X 2 X 10 3,000

#15, 8 1/2 X 3 1/2 X 14 1/2 1,000

Flat Counter / Card Bags

Stock # Size Qty / Case
605478 #12, 7 X 10 3,000
605479 #14, 9 X 11 2,000

Square Bottom Grocery / Lunch Bags

Stock # Size Qty / Case
605481
605482 #25, 5 3/4 X 3 3/4 X 10 5/8 2,000
605483
#26, 6 1/2 X 4 X 13 1/2 1,000

#28, 8 X 5 X 16 1/2 750

Brown paper bags and plastic t-shirt bags are also available.

800.235.0767 Shop more at integralsupplies.com/store/custom-products.php

HangUp® Retrieval Bags

Utilize our prescription retrieval system and save 25% in retrieval time.
What should you consider when designing your prescription retrieval system? What size
bags do you need, how many bags are waiting to be picked up at the busiest time of the day,
and how much wall or floor space is available for storage racks?

• Reusable bags are durable
• Clear 4 mil plastic bags
• Easy-open shatter-proof plastic handle
• Saves time and helps eliminate errors
• Improve customer service

Stock # 500101 Stock # 500103
HangUp 10.5 x 7.5 HangUp 12 x 9
10 bags / pack
10 bags / pack

Stock # 500104 Stock # 500105
HangUp 10.5 x 12.5 HangUp 14 x 12.5

10 bags / pack 10 bags / pack

 Shop more at integralsupplies.com/store/hangup-retrieval-bags www.integralsupplies.com

HangUp® Retrieval Bags

Stock # 500116 Organize your retrieval system
Retrieval Dividers with shatter-proof plastic index
tab dividers. Stick on letters and
25 / Pack numbers are included for custom
organizing of filled prescriptions.
Dividers fit on any .375” rod.

Store your empty HangUp® bags
on the bag caddy to keep them neatly
organized and quickly accessible for
future prescriptions. The Caddy stores
up to 40 bags and sits conveniently on
a counter top or can be wall mounted.

Stock # 500117
Bag Caddy

Deluxe racks are made with 1/2”
aluminum frames with 3/8” rods
for hanging bags. Various rack widths
are available to accommodate your
available storage space. Each rod will
hold 10 to 12 bags per linear foot.

Stock # Deluxe Wall Racks
500201 3 ft Wide with 4 Rods
500202 3 ft Wide with 5 Rods
500203 4 ft Wide with 4 Rods
500204 4 ft Wide with 5 Rods

**Available in
one, two and
three tier options.

Additional storage rack options are available.

800.235.0767 Shop more at integralsupplies.com/store/hangup-retrieval-bags 

Prescription Pad Supplies

Prescription Pads, RX Cards and File Folders

SECURITY FEATURES INCLUDE BLUE VOID PANTO, MICROPRINT BORDER & SIGNATURE LINES, AND HEAT SENSITIVE INK ON REVERSE Best Seller

SECURITY FEATURES INCLUDE BLUE VOID PANTO, MICROPRINT BORDER & SIGNATURE LINES, AND HEAT SENSITIVE INK ON REVERSE
TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMP
TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPNAMEDATENAMEDATENAMEDATE
ADDRESS D.O.B.
TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMPADDRESSGENDERD.O.B.GENDERADDRESSGENDERD.O.B.
TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMP
R

PLEASE LABEL PLEASE LABEL PLEASE LABEL

REFILL TIMES VOID AFTER REFILL TIMES VOID AFTER REFILL TIMES VOID AFTER

AUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGAU M.D. AUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUR M.D. M.D. M.D. M.D. M.D.
505406
DISPENSE AS WRITTEN SUBSTITUTION PERMITTED DISPENSE AS WRITTEN SUBSTITUTION PERMITTED AUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATURE AUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNA

SUBSTITUTION PERMITTED DISPENSE AS WRITTEN

DEA NO. ADDRESS 505407 DEA NO. ADDRESS DEA NO. ADDRESS 505401

TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRE TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPER

294310 353641

Stock # 505407 (SC) Stock # 505406 (SC) Stock # 505401
4 1/4” X 5 1/2” 4 1/4” X 5 1/2” 4 1/4” X 5 1/2”

TRANSFER PRESCRIPTION

FOR NAME TRANSFER DATE
ADDRESS ADDRESS
ORIGINAL RX # GENDER D.O.B.
ORIGINAL REFILLS
DATE PHARMACY NAME
PHARMACY ADDRESS
PHARMACIST TRANSFERING DATE OF ISSUE DATE FIRST FILLED

REFILLS REMAINING DATE LAST REFILL

DEA NO.

PHARMACIST RECEIVING

PLEASE LABEL

REFILL TIMES VOID AFTER

M.D. M.D.
505400
SUBSTITUTION PERMITTED DISPENSE AS WRITTEN M.D. M.D.
ADDRESS 505408
DISPENSE AS WRITTEN SUBSTITUTION PERMITTED

DEA NO. ADDRESS DEA NO.

Stock # 505400 Stock # 505408
4 1/4” X 5 1/2” 4 1/4” X 5 1/2”
Transfer Pad

Stock # 505402
8 1/2” X 11”

NAME
ADDRESS

Stock # 507200
7” X 4”

Stock # Size Stock # 403705
403700 1/2” Pocket 18” X 13 1/2”X 5”
403701 1” Pocket
403702 1 1/2” Pocket www.integralsupplies.com

 Shop more at integralsupplies.com/store/prescription-pads

Custom Prescription Pads

Security Prescription Paper

Our custom pads meet Centers for Medicare and Medicaid guidelines with seven standard security features
including security background, erasure protection, backprinting, microprinting, security watermark, coin
reactive ink and thermochromic ink. We can print your custom pad or you can use our standard designs.

TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMP SECURITY FEATURES INCLUDE BLUE VOID PANTO, MICROPRINT BORDER & SIGNATURE LINES, AND HEAT SENSITIVE INK ON REVERSE TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMP TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMP SECURITY FEATURES INCLUDE GREEN VOID PANTO, MICROPRINT BORDER & SIGNATURE LINES, AND HEAT SENSITIVE INK ON REVERSE TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMP

Physician’s Name Physician’s Name F PHARMAC

123 Physician Way 123 Physician Way
Anytown, SC 12345 Anytown, SC 12345
Phone: (864) 555-0450 Phone: (864) 555-0450
Fax: (864) 555-1315 Fax: (864) 555-1315

DEA# 0000000 DEA# 0000000

PATIENT NAME DATE PATIENT NAME DATE

ADDRESS GENDER D.O.B. ADDRESS GENDER D.O.B.

GDI140603309410  LABEL
GDI140603309410
 LABEL EORGIA STA
REFILL ________ TIMES PRN NR REFILL ________ TIMES PRN NR

PHYSICIAN SIGNATURE: PHYSICIAN SIGNATURE: TE BOARD O

AUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREA AUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREA Rx

This prescription may be filled with a generically equivalent drug product unless the words This prescription may be filled with a generically equivalent drug product unless the words SEAL OF APPROVAL
“Medically Necessary” are written in the practitioner’s own handwriting on this prescription form. “Medically Necessary” are written in the practitioner’s own handwriting on this prescription form.
1123212 YG
1123212
TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRE
TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRE

Florida Georgia

TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERR ESISTANTTAMPERRESISTANTTAMPERRESITAMP SECURITY FEATURES INCLUDE GREEN VOID PANTO, MICROPRINT BORDER & SIGNATURE LINES, AND HEAT SENSITIVE INK ON REVERSE TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMP TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERR ESISTANTTAMPERRESISTANTTAMPERRESITAMP SECURITY FEATURES INCLUDE BLUE VOID PANTO, MICROPRINT BORDER & SIGNATURE LINES, AND HEAT SENSITIVE INK ON REVERSE TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMP

Physician’s Name Physician’s Name

123 Physician Way 123 Physician Way
Anytown, SC 12345 Anytown, SC 12345
Phone: (864) 555-0450 Phone: (864) 555-0450
Fax: (864) 555-1315 Fax: (864) 555-1315

DEA# 0000000 DEA# 0000000

PATIENT NAME DATE PATIENT NAME DATE
ADDRESS
ADDRESS

Initial Quantity 1 -24
1 -24 25 - 49
25 - 49 50 - 74
50 - 74 75 - 100
75 - 100 101 - 150
101 - 150 151 and over
151 and over
Refill NR 1 2 3 4 5 Refill NR 1 2 3 4 5 Void after:

Signature Dispense as Witten May Substitute
AUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREA
1123212 Prescription is void if more than one (1) prescription is written per blank.
Prescription is void if more than one (1) prescription is written per blank.
1123212 TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRE

TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRE

Kentucky Indiana

TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMP SECURITY FEATURES INCLUDE BLUE VOID PANTO, MICROPRINT BORDER & SIGNATURE LINES, AND HEAT SENSITIVE INK ON REVERSE TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMP TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERR ESISTANTTAMPERRESISTANTTAMPERRESITAMP SECURITY FEATURES INCLUDE GREEN VOID PANTO, MICROPRINT BORDER & SIGNATURE LINES, AND HEAT SENSITIVE INK ON REVERSE TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESITAMP

Physician’s Name Physician’s Name

123 Physician Way 123 Physician Way
Anytown, SC 12345 Anytown, SC 12345
Phone: (864) 555-0450 Phone: (864) 555-0450
Fax: (864) 555-1315 Fax: (864) 555-1315

DEA# 0000000 DEA# 0000000

PATIENT NAME DATE PATIENT NAME DATE
ADDRESS
ADDRESS

1 -24 Refill NR 1 2 3 4 5 Void After _________
25 - 49
50 - 74 Any drug which is the generic equivalent of the drug specified above in this prescription may be dispensed,
75 - 100
101 - 150 provided no check mark has been handwritten in the box in the lower right hand corner.
151 and over
Signature
Refill NR 1 2 3 4 AUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREA

PHYSICIAN SIGNATURE: Prescription is void if more than one (1) prescription is written per blank.
1123212
AUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREAUTHORIZEDSIGNATUREA
TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRE
Prescription is void if more than one (1) prescription is written per blank.
Maine
1123212 This prescription may be filled with a generically equivalent drug product unless the words
“Brand Medically Necessary” are written in the practitioner’s own handwriting on this prescription form.

TAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRESISTANTTAMPERRE

West Virginia

800.235.0767 Shop more at integralsupplies.com/store/custom-products.php

Vials

Quality prescription vials and ovals are necessary to promote a professional image with your customers.
We offer several product lines to choose from including premium and economy products. The various
price points provide the right solution for your business and our generic brand meets all FDA
requirements.

Stock # Pro Plus Convertible Cap Stock # Pro One Reversible
200000 8 Dram 200022 11 Dram
200001 11 Dram 200023 13 Dram
200002 13 Dram 200024 16 Dram
200003 16 Dram 200025 20 Dram
200004 20 Dram 200026 30 Dram
200005 30 Dram 200027 40 Dram
200006 40 Dram 200028 60 Dram
200007 60 Dram

Stock # PERFECTPak Child Resistant Stock # Generic Reversible
200010 8 Dram 608030 8 Dram
200011 12 Dram 608031 13 Dram
200012 16 Dram 608032 16 Dram
200013 20 Dram 608033 20 Dram
200014 30 Dram 608034 30 Dram
200015 40 Dram 608035 40 Dram
200016 60 Dram 608036 60 Dram

 Shop more at integralsupplies.com/store/vials-and-ovals www.integralsupplies.com

Vials and Ovals

Stock # Generic Child Resistant Stock # ProMaxx Liquid Ovals
608041 8 Dram 200030 2 Ounce
608042 13 Dram 200031 3 Ounce
608043 16 Dram 200032 4 Ounce
608044 20 Dram 200033 6 Ounce
608045 30 Dram 200034 8 Ounce
608046 40 Dram 200035 12 Ounce
608047 60 Dram 200036 16 Ounce

Stock # Berry Liquid Ovals Stock # Generic Liquid Ovals
200041 2 Ounce 608050 2 Ounce
200042 3 Ounce 608051 4 Ounce
200043 4 Ounce 608052 6 Ounce
200044 6 Ounce 608053 8 Ounce
200045 8 Ounce 608054 12 Ounce
200046 12 Ounce 608055 16 Ounce
200047 16 Ounce

800.235.0767 Shop more at integralsupplies.com/store/vials-and-ovals

Cold Seal Medication Cards

One-Piece Cards

Cold seal cards are ideal for heat sensitive medications, STAT orders, and work well for any
size operation.

• Cards are designed to save time by preattaching the blister to the card.
• Product meets class B container requirements and measures 9” x 6” when folded.
• Package is sealed simply by applying pressure to the self-adhesive backing when folded.

A cork tray and hand roller are recommended to ensure a quick and effective seal.
See page 25 for blister dimensions.

Best Seller

31 Day Countdown 62 Day Countdown 90 Day Countdown

Blister Included Blister Included Blister Included

Stock # Size Color Stock # Size Color Stock # Size Color
900319 Large Clear 900622 Small Clear 900902 Small Clear

See Page 28 For Coordinating Corks.

 Shop more at integralsupplies.com/store/prescription-packaging www.integralsupplies.com

Cold Seal Medication Cards

Blisters Sold Separately. See Page 28 For Coordinating Corks.

Best Seller

31 Day Countdown 31 Day Calendar

Stock # 900310 Stock # 900311
Coordinating Blisters Coordinating Blisters

(Sold separately, pg. 2 5 ) (Sold separately, pg. 2 5 )

Stock # Size Color Stock # Size Color
900322 Small Clear 900322 Small Clear
900320 Medium Clear 900320 Medium Clear
900323 Large Clear 900323 Large Clear
900327 Extra Large Clear 900327 Extra Large Clear
900326 Large Amber 900326 Large Amber

60/62 Day Countdown 90 Day Countdown

Stock # 900620 Stock # 900900
Coordinating Blisters Coordinating Blisters

(Sold separately, pg. 2 5 ) (Sold separately, pg. 2 5 )

Stock # Size Color Stock # Size Color
900628 Small Clear 900908 Small Clear
900324 60/62 Small Amber

800.235.0767 Shop more at integralsupplies.com/store/prescription-packaging

Heat Seal Medication Cards

One-Piece Cards

Heat seal cards are ideal for large volume applications.
• Cards are designed to save time by preattaching the blister to the card.
• Product meets class B container requirements and measures 9” x 6” when folded.
• Package is sealed simply by applying heat and pressure to the adhesive backing when
sealed by a t-shirt press or an automated sealing machine.

Best Seller

30 Day Countdown 31 Day Countdown

Blister Included Blister Included

Stock # Size Color Stock # Size Color
900308 Large Clear 900318 Large Clear

See Page 28 and 29 For Paddles and Heat Sealing Equipment.

 Shop more at integralsupplies.com/store/prescription-packaging www.integralsupplies.com

Heat Seal Medication Cards

See Page 28 and 29 For Paddles and Heat Sealing Equipment.

Best Seller

30 Day Countdown 31 Day Countdown 31 Day Calendar

Stock # 900305 Stock # 900315 Stock # 900316
Coordinating Blisters Coordinating Blisters Coordinating Blisters

(Sold separately, pg. 2 5 ) (Sold separately, pg. 2 5 ) (Sold separately, pg. 2 5 )

Stock # Size Color Stock # Size Color Stock # Size Color
900325 Large Clear 900322 Small Clear 900322 Small Clear
900326 30/31 Large Amber 900320 Medium Clear 900320 Medium Clear
900323 Large Clear 900323 Large Clear
900327 Extra Large Clear 900327 Extra Large Clear
900326 Large Amber 900326 Large Amber

60/62 Day Countdown 90 Day Countdown

Stock # 900625 Stock # 900905
Coordinating Blisters Coordinating Blisters

(Sold separately, pg. 2 5 ) (Sold separately, pg. 2 5 )

Stock # Size Color Stock # Size Color
900628 Small Clear 900908 Small Clear
900324 60/62 Small Amber

800.235.0767 Shop more at integralsupplies.com/store/prescription-packaging

Clear and Amber Blisters Medium

Small

.385

Stock # Color Stock # Color
900322 31 Clear 900320 31 Clear

Large Best Seller Extra Large

.500 .750

Stock # Color Stock # Color
900325 30 Clear 900327 31 Clear
900323 31 Clear
900326 30/31 Amber

62 Dose 90 Dose 7/28 Dose

.625

.500 .335

Stock # Color Stock # Color Stock # Color
900628 Clear 900908 Clear 900289 Clear for Heat Seal
900324 60/62 Amber

 Shop more at integralsupplies.com/store/prescription-packaging www.integralsupplies.com

Multi-Dose Medication Cards

Tri-Fold Cards

Multi-Dose medication cards are available in cold seal and heat seal applications, and
organize all of your patients medications for a specified day and time into one blister.

• Cards are designed for quick and easy assembling.
• Product meets class B container requirements and measures 10” x 6” when folded.
• A cork tray and hand roller are recommended for cold seal cards to ensure a quick

and effective seal. A t-shirt press or an automated sealing machine are recommended
for heat seal cards to properly seal the adhesive.

Best Seller

7/28 Day Tri-Fold
Cold Seal

Stock # 900280

Kit Includes Card, Blister and Foam Tray

Morning Mid-day Evening Bedtime Bedtime Evening Mid-day Morning
S Mid-day Evening Bedtime Evening Mid-day Morning
U S
N U
N
M
7/28 Day Tri-Fold O M
N O
N
T
Heat Seal U T
Stock # 900285 E U
E
W
Coordinating Blisters E W weekly pill pack
D E
(Sold separately, pg. 2 5 ) T D
H T
Stock # Size Color U H
900289 Small Clear R U
F R
R F
I R
I
S
A S
T A
T
Morning
Bedtime

800.235.0767 Shop more at integralsupplies.com/store/prescription-packaging

Unit Dose Medication Cards

Reclaimable Cards

Our unit dose cards are ideal for reclaiming and reusing unused medications in states that
allow unused medications to be returned.

• Cards are designed for heat seal applications.
• Product meets class B container requirements and measures 9” x 6” when folded.
• Package is sealed simply by applying heat and pressure to the adhesive backing when

sealed by a t-shirt press or an automated sealing machine.

The face of the card separates to reclaim unused medication.

Medium Large

.385 .500

31 Day Countdown Stock # Color Stock # Color
900330 31 Clear 900331 31 Clear
Stock # 900305

Stock # Description Stock # Description Stock # Description
900050 Lidding Stock 900051 Tharo 6” Resin Ribbon 900055 Unit Dose Boxes

 Shop more at integralsupplies.com/store/prescription-packaging www.integralsupplies.com

Packaging Equipment

Corks and Paddles Stock # 900002 Stock # 900003
60/62 Dose Cork, Cold Seal 90 Dose Cork, Cold Seal
Stock # 900001
30/31/32 Dose Cork, Cold Seal

Stock # 900004 Stock # 900005 Stock # 900006
30/31/32 Dose 2-Up Paddle 60/62 Dose 2-Up Paddle 90 Dose 2-Up Paddle
5/8” thick, Heat Seal 5/8” thick, Heat Seal 5/8” thick, Heat Seal

Stock # 900007 Stock # 900010 Stock # 900000
28 Dose Tri-Fold Paddle Unit Dose 2-Up Paddle Cold Seal Roller
5/8” thick, Heat Seal 5/8” thick, Heat Seal

800.235.0767 Shop more at integralsupplies.com/store/prescription-packaging

Packaging Equipment

Heat Sealers Integral Solutions offers a range of equipment to
create the perfect sealing solution in almost any
Stock # 605280 pharmacy from manual heat sealers to high volume
Stock # 605281 electric heat sealers.

SafeSealRx

• Preprogrammed digital controls
• Manual heat sealer
• Auto opening
• 27 H x 15 3/4 W x 23 D

Gemini

• Automatically opens when sealed
• Easiest sealer to use
• Internal timer eliminates over or under

sealing blisters
• 8 5/8 H x 16 W x 22 1/4 D

Stock # 605284 AutoGen
Stock # 605282
• Automatically opens when sealed
• Whisper-quiet operation
• Enhanced air flow design creates lower

heated air emissions
• 13 H x 14 1/8 W x 33 D

Autobond

• Temperature and time control
• Requires compressed air
• For low volume sealing requirements
• 10 1/4 H x 21 1/2 W x 21 7/8 D

 Shop more at integralsupplies.com/store/prescription-packaging www.integralsupplies.com

Ring Binders

Titan Ring Binder Charts
Our charts are designed to keep patient records private when the chart is in public view. The binders are
constructed with materials for durability that lasts. Side-opening and top-opening chart designs are available
in a variety of ring diameters ranging from 1/2” up to 4”. Most chart sizes are available in 20 different colors.
See below for details.

Side Opening Charts

Ring Size Ring Count Page Capacity Overall Spine
1/2” 3 100 1 1/8”
1” 3 150 1 1/2”
1 1/2” 250 2 1/4”
2” 3 or 5 300 2 1/4”
3” 3 or 5 400 2 3/4”
4” 3 or 5 575 3 5/8”

3

Top Opening Charts

Ring Size Ring Count Page Capacity Overall Spine
1” 3 150 1 1/4”
250 2 1/4”
1 1/2” 2, 3 or 5 300 2 1/4”
2” 2, 3 or 5 400 2 3/4”
3” 3 or 5

Choose from 20 Colors

01 02 06 07 08 09 21 23 24 25 26 27 28 34 35 36 37 38 39 40 01 Seafoam Green 23 Charcoal Gray 34 Olive Green
02 Burgundy 24 Powder Blue 35 Mulberry
06 Brown 25 Yellow 36 Navy Blue
07 Mauve 26 Hunter Green 37 Gray
08 Light Blue 27 Teal 38 Goldenrod
09 Beige 28 Black 39 Taupe
21 Red 40 Sierra

800.235.0767 Shop more at integralsupplies.com/store/ring-binders 

Physician Orders

Long Term Care forms are available in laser, dot matrix and multi-part formats.

Each form is printed with a static barcode allowing for automated routing when used with electronic document
management software such as the Integra DocuTrack system. Our forms are compatible with many software
applications. Below are examples of popular styles. (Check with your software provider for programming.)

PHYSICIAN’S ORDERS PHYSICIAN’S HOUR ORDERS PHYSICIAN’S HOUR ORDERS
ORDERS ORDERS
MEDICATIONS
MEDICATIONS MEDICATIONS

HOUR ORDERS REORDER FROM INTEGRAL SOLUTIONS GROUP • 1-800-235-0767

STOCK # 502255 REORDER FROM INTEGRAL SOLUTIONS GROUP • 1-800-235-0767 STOCK # 502256 STOCK # 502257 REORDER FROM INTEGRAL SOLUTIONS GROUP • 1-800-235-0767

www.integralsupplies.com www.integralsupplies.com FORM A-61 www.integralsupplies.com FORM A-75

FORM A55, A76, A81 STOCK # 502256

50_265589 50-263641

50_267614 Rev. 10/12

Rev. 3/13 MEDS REVIEWED BY: DATE: PHYSICIANS SIGNATURE DATE: REV. 10/12
CHARTING FOR THROUGH
MEDS REVIEWED BY: PHYSICIANS SIGNATURE Physician
DATE: THROUGH DATE: Alt. Physician Telephone No. Medical Record No. MEDS REVIEWED BY: PHYSICIANS SIGNATURE
CHARTING FOR Allergies Alt. Telephone THROUGH
Physician Date: CHARTING FOR
Alt. Physician Diagnosis Admission Physician DATE: DATE:
Allergies Date Alt. Physician
Telephone No. Medical Record No. Medicaid Number Telephone No. Medical Record No.
Diagnosis Alt. Telephone Allergies Alt. Telephone
Medicaid Number Date: RESIDENT Diagnosis Date:
Rehabilitative Admission Rehabilitative Admission
RESIDENT Potential Date Medicaid Number Potential Date

Medicare Number Complete Entries Checked Medicare Number Complete Entries Checked: RESIDENT

By: Title: By: Sex Room Title: Medicare Number Complete Entries Checked:
D.O.B. Patient D.O.B. # Patient
Sex Room Code Code
# By: Title:
D.O.B. Sex Room Patient
# Code

Stock # 502255 Stock # 502256 Stock # 502257
1 Part PO 1 Part PO 1 Part PO

Best Seller

PHYSICIAN’S ORDERS PHYSICIAN’S ORDERS PHYSICIAN’S ORDERS

STOCK # 502435 STOCK # 502435 STOCK # 502435

www.integralsupplies.com FORM A-70 www.integralsupplies.com FORM A-70 www.integralsupplies.com FORM A-70

264097 264097 264097

REV. 10/12 REV. 10/12 REV. 10/12

Stock # 502434 Stock # 502435 Stock # 502436
** 2 Part PO ** 2 Part PO, 1 Part MAR ** 3 Part PO

ADMISSION ADTE NURSE’S MEDICATION NOTES Result Codes: Injection/Patch Site Code: 8- Left Deltoid 15- Upper Chest Left
Instructions: 1. Effective 1- Right Dorsal Gluteus 9- Right Upper Arm 16- Upper Chest Right
Stock # 502206 A. Put initials in appropriate box when medication is given. 2. Ineffective 2- Left Dorsal Gluteus 10- Left Upper Arm 17- To Right and Above Level of Umbilicus
3 Part PO B. Circle initials when medication is refused. 3. Slightly Effective 3- Right Ventral Gluteus 11- Right Anterior Thigh 18- To Left and Above Level of Umbilicus
4. No Effect Observed 4- Left Ventral Gluteus 12- Left Anterior Thigh 19- To Right and Below Level of Umbilicus
C. State reason for refusal on Nurse’s Notes. 5- Right Lateral Thigh 13- Upper Back Left 20- To Left and Below Level of Umbilicus
D. PRN medication: Reason given should be noted on Nurse’s Notes. 6- Left Lateral Thigh 14- Upper Back Right
7- Right Deltoid
E. Indicate injection site (code).

DAY SHIFT color ink EVENING SHIFT color ink NIGHT SHIFT color ink

Charting Codes: A. CHARTED IN ERROR. B. DRUG TEMPORARILY UNAVAILABLE. C. RESIDENT REFUSED. D. DRUG HELD: IN NURSE’S JUDGEMENT DRUG INAPPROPRIATE OR NOT NEEDED AT THAT TIME.
E. RESIDENT VOMITED OR SPIT OUT MEDICATION. DOSAGE ABSORBED QUESTIONABLE. F. RESIDENT OUT OF FACILITY. G. SEE NURSE’S NOTES. H. DRUG HOLIDAY.

DATE / HOUR MEDICATION / DOSAGE ROUTE REASON INITIALS RESULTS / RESPONSE SIGNATURE/INITIALS ** The multi-part laser forms have been
tested and approved to print on HP laser
STOCK # 502206 printers for the best reliability.

FORM A02 Laser MAR’s are made with 24# paper to
withstand daily usage and charting.
REV.11/12 www.integralsupplies.com
Customizations Available
REORDER FROM INTEGRAL SOLUTIONS GRPAORUTAPNSBURG, SC 1-(800) 235-0767 SIGNATURE/INITIALS RESULTS / RESPONSE INITIALS REASON ROUTE MEDICATION / DOSAGE DATE / HOUR

H. DRUG HOLIDAY. G. SEE NURSE’S NOTES. E. RESIDENT VOMITED OR SPIT OUT MEDICATION. DOSAGE ABSORBED QUESTIONABLE. F. RESIDENT OUT OF FACILITY. Charting Codes:
D. DRUG HELD: IN NURSE’S JUDGEMENT DRUG INAPPROPRIATE OR NOT NEEDED AT THAT TIME. C. RESIDENT REFUSED. A. CHARTED IN ERROR. B. DRUG TEMPORARILY UNAVAILABLE.

NIGHT SHIFT color ink EVENING SHIFT color ink DAY SHIFT color ink

15- Upper Chest Left 8- Left Deltoid Injection/Patch Site Code: Result Codes: NURSE’S MEDICATION NOTES
16- Upper Chest Right 9- Right Upper Arm 1- Right Dorsal Gluteus 1. Effective Instructions:
17- To Right and Above Level of Umbilicus 10- Left Upper Arm 2- Left Dorsal Gluteus 2. Ineffective A. Put initials in appropriate box when medication is given.
18- To Left and Above Level of Umbilicus 11- Right Anterior Thigh 3- Right Ventral Gluteus 3. Slightly Effective B. Circle initials when medication is refused.
19- To Right and Below Level of Umbilicus 12- Left Anterior Thigh 4- Left Ventral Gluteus 4. No Effect Observed C. State reason for refusal on Nurse’s Notes.
20- To Left and Below Level of Umbilicus 13- Upper Back Left 5- Right Lateral Thigh D. PRN medication: Reason given should be noted on Nurse’s Notes.
14- Upper Back Right 6- Left Lateral Thigh E. Indicate injection site (code).
7- Right Deltoid

SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS

SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 BLOOD PRESSURE
BLOOD PRESSURE

PAIN
WEIGHT
RESPIRATION
PULSE
TEMPERATURE

MAR Backer
Laser
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
TEMPERATURE

PULSE
RESPIRATION

WEIGHT
PAIN

 Shop more at integralsupplies.com/store/physician-orders www.integralsupplies.com

Physician Orders

Long Term Care forms are available in laser, dot matrix and multi-part formats.

Each form is printed with a static barcode allowing for automated routing when used with electronic document
management software such as the Integra DocuTrack system. Our forms are compatible with many software
applications. Below are examples of popular styles. (Check with your software provider for programming.)

PHYSICIAN’S ORDERS PHYSICIAN’S ORDER SHEET PATIENT NAME PHYSICIAN’S ORDERS PART 1 WHITE
QS/1 PHARMACY SYSTEM FORM A11 HOUR
MEDICATIONS PHYSICIAN MEDICATIONS

HOUR ORDERS AUDITED BY: PATIENT I.D. NO. ORDERS

207824 ROOM NO. DISCONTINUED
GENERIC EQUIVALENT IS AUTHORIZED UNLESS INITIALED IN THIS COLUMN OPPOSITE DRUG NAME BY:
FORM A03 • A23 • A30 • A42 • A64 • A72
DIAGNOSIS DATE TIME INITIAL STOCK # 502300

FORM A05 • A29 • A34 STOCK # 502223 ALLERGIES PHYSICIAN’S ORDERS AND SIGNATURE
STOCK # 502221 DATE TIME

REV.09/12 www.integralsupplies.com REV.09/12 www.integralsupplies.com

REORDER FROM INTEGRAL SOLUTIONS GRPAORUTAPNSBURG, SC 1-(800) 235-0767 REORDER FROM: INTEGRAL SOLUTIONS GROUP SPARTANBURG, SC (800) 235-0767 When Sending Copies to Pharmacy REORDER FROM INTEGRAL SOLUTIONS GROUP SPARTANBURG, SC 1-(800) 235-0767
Send Canary Pharmacy copy 1st.
Send Pink Pharmacy copy 2nd.
Send Gold Pharmacy copy 3rd.

DRUG REGIMENY: B DATE: PHYSICIANS SIGNATURE DATE: MEDS REVIEWED BY: DATE: PHYSICIANS SIGNATURE DATE:
PATIENT CODE THROUGH
CHARTINGFOR THROUGH CHARTING FOR
PHYSICIAN PHYSICIAN
PHONE NO. PLEASECHECKCOMPLETE ENTREI S -VERIFY AND INITIAL ALT. PHY. TELEPHONE NO. MED. RECORD NO.
ALLERGIES ALT. TELEPHONE
DIET PHARMACY FACILITY REHABILITATIVE
AGE DIAGNOSIS
ALLERGIES WEIGHT SEX MEDICAID NUMBER POTENTIAL

DIAGNOSIS MED. RECORD NO. ADMISSION DATE PATIENT ADMISSION DATE

PATIENT HABILITATIVE/ REHABILITATIVEPOTENTIAL MEDICARE NUMBER COMPLETE ENTRIES CHECKED

MEDICAID NUMBER MEDICARE NUMBRE ROOM NO. BED IMPORTANT: PHARMACY MUST RECEIVE A COPY OF ALL MEDICATION ORDERS (NEW & CHANGE ORDERS) BY: DATE OF BIRTH TITLE:
PLEASE BE SURE A PHARMACY COPY IS BELOW BEFORE USING! SEX PATIENT CODE ROOM NO. BED FACILITY CODE
ORIGINAL
Stock # 502221 Stock # 502300
2 Part PO, 1 Part MAR Stock # 502223 2 Part PO
4 Part PO

PHYSICIAN’S ORDERS HOUR ORDERS PHYSICIAN’S ORDERS PART 1 WHITE Best Seller PHYSICIAN’S ORDERS HOUR ORDERS
HOUR
MEDICATIONS MEDICATIONS ORDERS MEDICATIONS

FORM A03 • A23 • A30 • A42 • A64 • A72 FORM A03 • A23 • A30 • A42 • A64 • A72 FORM A03 • A23 • A30 • A42 • A64 • A72
STOCK # 502301 STOCK # 502322 STOCK # 502324

REV.09/12 www.integralsupplies.com REV.09/12 www.integralsupplies.com REV.09/12 www.integralsupplies.com

REORDER FROM INTEGRAL SOLUTIONS GROUP SPARTANBURG, SC 1-(800) 235-0767 REORDER FROM INTEGRAL SOLUTIONS GROUP SPARTANBURG, SC 1-(800) 235-0767 REORDER FROM INTEGRAL SOLUTIONS GRPAORUTAPNSBURG, SC 1-(800) 235-0767

MEDS REVIEWED BY: DATE: PHYSICIANS SIGNATURE DATE: MEDS REVIEWED BY: DATE: PHYSICIANS SIGNATURE DATE: POSTING DATE: PHYSICIANS SIGNATURE DATE:
THROUGH THROUGH THROUGH
CHARTING FOR CHARTING FOR 50_263418 CHARTINGFOR
PHYSICIAN TELEPHONE NO. MED. RECORD NO. PHYSICIAN TELEPHONE NO. MED. RECORD NO. PHYSICIAN TELEPHONE NO. MED. RECORD NO.
ALT. PHY. ALT. TELEPHONE ALT. PHY. ALT. TELEPHONE ALT. PHY. ALT. TELEPHONE
ALLERGIES REHABILITATIVE ALLERGIES REHABILITATIVE 10-12 ALLERGIES REHABILITATIVE

DIAGNOSIS POTENTIAL DIAGNOSIS POTENTIAL DIAGNOSIS POTENTIAL
MEDICAID NUMBER MEDICAID NUMBER MEDICAID NUMBER
ADMISSION DATE ADMISSION DATE ADMISSION DATE
PATIENT PATIENT PATIENT
MEDICARE NUMBER COMPLETE ENTRIES CHECKED MEDICARE NUMBER COMPLETE ENTRIES CHECKED MEDICARE NUMBER VERIFICATION TITLE:
ROOMNO. BED FACILITYCODE
BY: DATE OF BIRTH TITLE: BY: DATE OF BIRTH TITLE: BY: DATE OF BRITH PATIENTCODE
SEX PATIENT CODE ROOM NO. BED FACILITY CODE SEX PATIENT CODE ROOM NO. BED FACILITY CODE SEX

Stock # 502301 Stock # 502322 Stock # 502324
3 Part PO 2 Part PO, 1 Part MAR 2 Part PO, 1 Part MAR

NURSE’S MEDAICTION NOTES Result Codes: Injection /PatchSiteCode: 8- Left Deltoid 15- Upper Chest Left NURSE’S MEDICATION NOTES Result Codes: Injection/Patch Site Code: 8- Left Deltoid 15- Upper Chest Left
Instructoi ns: 1. E ve 1- Right Dorsal Gluteus 9- Right Upper Arm 16- Upper Chest Right Instructions: 1. Effective 1- Right Dorsal Gluteus 9- Right Upper Arm 16- Upper Chest Right
A. Put initials ni appropriate boxwhen medication is gvien. 2. Ine 2- Left Dorsal Gluteus 10- Left Upper Arm 17- To Right andAboveLevel of Umbilicus A. Put initials in appropriate box when medication is given. 2. Ineffective 2- Left Dorsal Gluteus 10- Left Upper Arm 17- To Right and Above Level of Umbilicus
B. Circle initials when medication is refused. 3. Slightly E 3- RightVentral Gluteus 11- Right Anterior Thigh 18- To Left andAbove Levelof Umbilicus B. Circle initials when medication is refused. 3. Slightly Effective 3- Right Ventral Gluteus 11- Right Anterior Thigh 18- To Left and Above Level of Umbilicus
C. Statereason for refusal on Nurse’s Notes. 4. No E 4- LeftVentral Gluteus 12- Left Anterior Thigh 19- To Right andBelowLevel of Umbilicus C. State reason for refusal on Nurse’s Notes. 4. No Effect Observed 4- Left Ventral Gluteus 12- Left Anterior Thigh 19- To Right and Below Level of Umbilicus
5- Right Lateral Thigh 13- Upper Back Left 20- To Left andBelow Level of Umbilicus D. PRN medication: Reason given should be noted on Nurse’s Notes. 5- Right Lateral Thigh 13- Upper Back Left 20- To Left and Below Level of Umbilicus
D. PRNmedication:Reasongiven should be noted on Nurse’s Notes. 6- Left Lateral Thigh 14- Upper Back Right E. Indicate injection site (code). 6- Left Lateral Thigh 14- Upper Back Right
E. Indicate injectionsite (code). 7- Right Deltoid 7- Right Deltoid

DAY SHIFT color ink EVENING SHIFTcolor ink NIGHT SHIFT color ink DAY SHIFT color ink EVENING SHIFT color ink NIGHT SHIFT color ink

Charitng Codes: A. CHARTED IN ERROR. B. DRUG TEMPORALRYIUNAVAILABLE. C. RESIDENT REFUSED. D. DRUG HELD: INNURSE’SJUDGEMENTDRUGINAPPROPRIATEORNOTNEEDEDAT THAT TIME. Charting Codes: A. CHARTED IN ERROR. B. DRUG TEMPORARILY UNAVAILABLE. C. RESIDENT REFUSED. D. DRUG HELD: IN NURSE’S JUDGEMENT DRUG INAPPROPRIATE OR NOT NEEDED AT THAT TIME.
E. RESIDENT VOMITEDOR SPITOUTMEDICATION. DOSAGE ABSORBED QUESTIONABLE. F. RESIDENT OUT OFAFCILITY. G. SEE NURSE’S NOTES. H. DRUG HOLIADY. E. RESIDENT VOMITED OR SPIT OUT MEDICATION. DOSAGE ABSORBED QUESTIONABLE. F. RESIDENT OUT OF FACILITY. G. SEE NURSE’S NOTES. H. DRUG HOLIDAY.

DATE / HOUR MEDICATION/ DOSAGE ROUTE REASON INITIALS RESULTS/ RESPONSE SIGNATURE/INITIALS DATE / HOUR MEDICATION / DOSAGE ROUTE REASON INITIALS RESULTS / RESPONSE SIGNATURE/INITIALS

SIGNATURE/INITIALS RESULTS/ RESPONSE INITIALS REASON ROUTE MEDICATION/ DOSAGE DATE / HOUR SIGNATURE/INITIALS RESULTS / RESPONSE INITIALS REASON ROUTE MEDICATION / DOSAGE DATE / HOUR

G. SEE NURSE’S NOTES. H. DRUG HOLIADY. F. RESIDENT OUT OFFACILITY. E. RESIDENTVOMITED ORS IPTOUTMEDICATION. DOSAGE ABSORBED QUESTIONABLE. ChartingCodes: H. DRUG HOLIDAY. G. SEE NURSE’S NOTES. E. RESIDENT VOMITED OR SPIT OUT MEDICATION. DOSAGE ABSORBED QUESTIONABLE. F. RESIDENT OUT OF FACILITY. Charting Codes:
D. DRUGHELD: IN NURSE’SJUDGEMENT DRUG INAPPRAOTPERIOR NOT NEEDEATD THAT TIM .E C. RE ISDENT REFUSED. B. DRUG TEMPORALRYIUNAVAILABLE. A. CHARTED INERROR. D. DRUG HELD: IN NURSE’S JUDGEMENT DRUG INAPPROPRIATE OR NOT NEEDED AT THAT TIME. C. RESIDENT REFUSED. A. CHARTED IN ERROR. B. DRUG TEMPORARILY UNAVAILABLE.

NIGHT SHIFT color ink EVENING SHIFTcolor ink DAY SHIFT color ink NIGHT SHIFT color ink EVENING SHIFT color ink DAY SHIFT color ink

15- Upper Chest Left 8- Left Deltoid Injection /PatchSiteCode: Res lut Codes: NURSE’S MEDIATCION NOTES 15- Upper Chest Left 8- Left Deltoid Injection/Patch Site Code: Result Codes: NURSE’S MEDICATION NOTES
16- Upper Chest Right 9- Right Upper Arm 1- Right Dorsal Gluteus 1. E ve Instru tcions: 16- Upper Chest Right 9- Right Upper Arm 1- Right Dorsal Gluteus 1. Effective Instructions:
17- To Right and Above Levelof Umbilicus 10- Left Upper Arm 2- Left Dorsal Gluteus 2. Ine A. Put initials in appropriate box whenmedication is given. 17- To Right and Above Level of Umbilicus 10- Left Upper Arm 2- Left Dorsal Gluteus 2. Ineffective A. Put initials in appropriate box when medication is given.
18- To Left and AboveLevel of Umbilicus 11- Right Anterior Thigh 3- RightVentral Gluteus 3. Slightly E B. Circle initials when medication isrefused. 18- To Left and Above Level of Umbilicus 11- Right Anterior Thigh 3- Right Ventral Gluteus 3. Slightly Effective B. Circle initials when medication is refused.
19- To Right and Below Level of Umbilicus 12- Left Anterior Thigh 4- LeftVentral Gluteus 4. No E C. Statereason forrefusalon Nurse’s Notes. 19- To Right and Below Level of Umbilicus 12- Left Anterior Thigh 4- Left Ventral Gluteus 4. No Effect Observed C. State reason for refusal on Nurse’s Notes.
20- To Left and Below Level ofUmbilicus 13- Upper Back Left 5- Right Lateral Thigh D. PRNmedication:Reasongiven should benoted on Nurse’s Notes. 20- To Left and Below Level of Umbilicus 13- Upper Back Left 5- Right Lateral Thigh D. PRN medication: Reason given should be noted on Nurse’s Notes.
14- Upper Back Right 6- Left Lateral Thigh E. Indicate injection site (code). 14- Upper Back Right 6- Left Lateral Thigh E. Indicate injection site (code).
7- Right Deltoid 7- Right Deltoid

SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS

SIGNATURE & TITEL INITIALS SIGNATURE & TITLE INITIALS SIGNATURE& TITLE BLOOD PRESSURE SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS
INITIALS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 BLOOD PRESSURE
BLOOD PRESSEUR BLOOD PRESSURE
TEMPERATURE
PAIN PULSE PAIN
WEIGHT WEIGHT
RESPIRATION RESPIRATION RESPIRATION
PULSE WEIGHT PULSE
TEMPERATURE PAIN TEMPERATURE

MAR Backer MAR Backer
Dot Matrix Laser
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
TEMPERATURE

PULSE
RESPIRATION

WEIGHT
PAIN

800.235.0767 Shop more at integralsupplies.com/store/physician-orders 

Medication Records

Long Term Care forms are available in laser, dot matrix and multi-part formats.

Each form is printed with a static barcode allowing for automated routing when used with electronic document
management software such as the Integra DocuTrack system. Our forms are compatible with many software
applications. Below are examples of popular styles. (Check with your software provider for programming.)

Best Seller

MEDICATION ADMINISTRATION RECORD

MEDICATIONS HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REORDERFROM INTEGRAL SOLUTIONSGROUP •1-800-2350-767

STOCK # 506460 STOCK # 506461 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REORDER FROM INTEGRAL SOLUTIONS GROUP • 1-800-235-0767 STOCK# 506473
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
www.integralsupplies.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 FORM A-62
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
FORM A55, A76, A81 www.integralsupplies.com FORM A55, A76, A81 www.integralsupplies.com
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
50_264477 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 50_263201 7 50_26871
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REV. 9/12

REV. 11/12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ev. R5/13
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 THROUGH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

CHARTING FOR THROUGH Telephone No.
Physician Alt. Telephone
Alt. Physician
Allergies Telephone No. Medical Recrod No.
Alt. Telephone

Rehabilitative
Potential

Complete EntriesChecked Diagnosis Medicare Number CompleteEntriesChecked
Medicaid Number
Stock # 506460 By: Sex Room Title: Date: Room Admission
1 Part MAR RESIDENT D.O.B. # Patient Admission # Date
Code Date
7 Day Charting Stock # 506473
Stock # 506461 1 Part MAR
1 Part MAR

AMRDEEMCDIOICNRADISTTIROANTION HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MEDICATION ADMINISTRATIONRECORD MEDICATION ADMINISTRATIONRECORD
MEDICATIONS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MEDICATIONS HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MEDICATIONS HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 50_263200 FORM A03 • A23 • A30 • A42 • A64 • A72 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 FORM A03 • A23 • A30 • A42 • A64 • A72 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 STOCK # 506452 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 STOCK # 506456 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
STOCK # 506475 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REORDER FROM INTEGRAL SOLUTIONS GROUP • 1-800-F2O35R-M07A6-775 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

www.integralsupplies.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REV.09/12 www.integralsupplies.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REV.09/12 www.integralsupplies.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
REORDER FROM INTEGRAL SOLUTIONS GRPAORUTAPNSBURG, SC 1-(800) 235-0767 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REORDER FROM INTEGRAL SOLUTIONS GRPAORUTAPNSBURG, SC 1-(800) 235-0767 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 RV.E9/12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

50_263689 CHARTINGFOR THROUGH CHARTINGFOR THROUGH
PHYSICIAN PHYSICIAN
CHARTING FOR THROUGH ALT. PHY. TELEPHONE NO. MED. RECORD NO. ALT. PHY. TELEPHONE NO. MED. RECORD NO.
Physician ALLERGIES ALT. TELEPHONE ADMISSION DATE ALLERGIES ALT. TELEPHONE ADMISSION DATE
Alt. Physician Telephone No. Medical Recrod No. 10-12 REHABILITATIVE REHABILITATIVE
Alt. Telephone DIAGNOSIS DIAGNOSIS
Allergies Date: MEDICAID NUMBER POTENTIAL MEDICAID NUMBER POTENTIAL
Diagnosis Rehabilitative Admission
Potential Date PATIENT PATIENT
Medicaid Number
MEDICARE NUMBER COMPLETE ENTRIESCHECKED MEDICARE NUMBER COMPLETE ENTRIESCHECKED
RESIDENT
Medicare Number Complete Entries Checke: d BY: TITLE: BY: TITLE:
SEX ROOMNO. BED FACILITYCODE SEX ROOMNO. BED FACILITYCODE
By: Title: DATE OF BRITH PATIENTCODE DATE OF BRITH PATIENTCODE
Patient
D.O.B. Sex Room Code
#

Stock # 506475 Stock # 506452 Stock # 506456
1 Part MAR 1 Part MAR 1 Part MAR

MEDICATION / TREATMENT RECORD MEDICATION RECORD REV. 9/12 Medicatoi ns HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
HOUR
348039
REV. 09/12 REORDER FROM: INTEGRAL SOLUTIONS GROUP 800-235-0767 STOCK # 506410 FORM M05 JOB#: 348698 www.integralsupplies.com MEDICATION/TREATMENT HOUR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
www.integralsupplies.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

REORDER FROM INTEGRAL SOLUTIONS GROUP 1-800-235-0767 FORM M08 STOCK# 506429 REV. 10/12 www.integralsupplies.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

REORDERFROM: INTEGRAL SOLUTIONSGROUP 800-235-0767 FORM M-59 STOCK # 506559 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

PHYSICIAN TELEPHONE NO. ALTERNATE TELEPHONE NO. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
DIAG- FIRST NAME RESTORATIVE POTENTIAL
NOSIS ALLERGIES Physician Telephone No. Diagnossi Store Name
PATIENT
CHARTING FOR THROUGH FACILITY
DIAG - PHYSICIAN
LAST NAME MID PATIENT NO. ROOM BED FACILITY CODE DATE PAGE NO. NOSIS ALLERGIES Resident/Paitent/Client Room Bed PatientCode Admin.Date Sex Dateof Birth Allergies Charting For/Through Page No.
INIT.
PATIENT
NAME PATIENT NO. STA ROOM BED TELEPHONE NO. DATE PAGE NO.

50_263199

Stock # 506410 Stock # 506429 Stock # 506559
1 Part MAR / TR 1 Part MAR / TR 1 Part MAR / TR

 Shop more at integralsupplies.com/store/medication-records www.integralsupplies.com

Medication Records

Long Term Care forms are available in laser, dot matrix and multi-part formats.

Each form is printed with a static barcode allowing for automated routing when used with electronic document
management software such as the Integra DocuTrack system. Our forms are compatible with many software
applications. Below are examples of popular styles. (Check with your software provider for programming.)

MEDICATION ADMINISTRATION AND HOUR REORDER FROM: INTEGRAL SOLUTIONS GROUP 800-235-0767 STOCK # 506570 FORM M75 50_263125 www.integralsupplies.com
CENTRALLY STORED MEDICATION RECORD

MEDICATIONS

REORDER FROM INTEGRAL SOLUTIONS GROUP 1-800-235-0767 FORM M68 STOCK # 506568 www.integralsupplies.com Rev. 10/12 REV. 09/12

D - DISCONTINUE H - HOME HP - HOSPITAL R - REFUSE
THROUGH
CHARTING FOR
COMPLETE ENTRIES CHECKED
COMMENTS BY:

ALLERGIES

DIAGNOSIS

ADMIT DATE INS. CODE TITLE: ADMINISTRATOR
PATIENT CODE
D.O.B. SEX ROOM NO. BED

PATIENT

Stock # 506560 Stock # 506568 Stock # 506570
1 Part MAR / TR 1 Part MAR 1 Part MAR / TR

Best Seller

REORDEFRROM: INTEGRASLOLUTIONSGROUP800-235-0767STOCK # 506571FORM M75 50_263232 www.integralsupplies.com WEIGHT

REV. 09/12

Stock # 506571 MAR / TR Backer MAR Backer
1 Part MAR / TR Laser Laser

NURSE’S MEDAICTION NOTES Result Codes: Injection /Patch SiteCode: 8- Left Deltoid
Instrucitons: 1. E ve 1- Right Dorsal Gluteus 9- Right Upper Arm
A. Put initials in appropriate box whenmedication is given. 2. Ine 2- Left Dorsal Gluteus 10- Left Upper Arms 15- Upper Chest Left
NURSE’S MEDAICTION NOTES Injection /PatchSiteCode: NURSE’S MEDICATION NOTES Injection/Patch Site Code: 3. Slightly E 3- RightVentral Gluteus 11- Right Anterior Thigh 16- Upper Chest Right
Instructoi ns: Result Codes: 1- Right Dorsal Gluteus 8- Left Deltoid 15- Upper Chest Left Instructions: Result Codes: 1- Right Dorsal Gluteus 8- Left Deltoid 15- Upper Chest Left B. Circle initials when medication isrefused. 4. No E 4- LeftVentral Gluteus 12- Left Anterior Thigh 17- To Right and Above Level of Umbilicus
1. E ve 2- Left Dorsal Gluteus 9- Right Upper Arm 16- Upper Chest Right 1. Effective 2- Left Dorsal Gluteus 9- Right Upper Arm 16- Upper Chest Right EVENINGSHIFT color ink 5- Right Lateral Thigh 13- Upper Back Left 18- To Leftand Above Level ofUmbilicus
2. Ine 3- RightVentral Gluteus 10- Left Upper Arm 17- To Right andAboveLevel of Umbilicus 2. Ineffective 3- Right Ventral Gluteus 10- Left Upper Arm 17- To Right and Above Level of Umbilicus C. Statereason for refusal on Nurse’s Notes. 6- Left Lateral Thigh 14- Upper Back Right 19- To Right and Below Level of Umbilicus
3. Slightly E 4- LeftVentral Gluteus 11- Right Anterior Thigh 18- To Left andAbove Levelof Umbilicus 3. Slightly Effective 4- Left Ventral Gluteus 11- Right Anterior Thigh 18- To Left and Above Level of Umbilicus D. PRN medication: Reason gvien shouldbe notedon Nurse’s Notes. 7- Right Deltoid 20- To Leftand Below Level of Umbilicus
A. Put initials ni appropriate boxwhen medication is gvien. 4. No E 5- Right Lateral Thigh 12- Left Anterior Thigh 19- To Right andBelowLevel of Umbilicus A. Put initials in appropriate box when medication is given. 4. No Effect Observed 5- Right Lateral Thigh 12- Left Anterior Thigh 19- To Right and Below Level of Umbilicus
B. Circle initials when medication is refused. 6- Left Lateral Thigh 13- Upper Back Left 20- To Left andBelow Level of Umbilicus B. Circle initials when medication is refused. 6- Left Lateral Thigh 13- Upper Back Left 20- To Left and Below Level of Umbilicus E. Indicate injection site (code.)
C. Statereason for refusal on Nurse’s Notes. 7- Right Deltoid 14- Upper Back Right C. State reason for refusal on Nurse’s Notes. 7- Right Deltoid 14- Upper Back Right
D. PRN medication: Reason given should be noted on Nurse’s Notes. DAY SHIFT color ink NIGHT SHIFT color ink
D. PRNmedication:Reasongiven should be noted on Nurse’s Notes. E. Indicate injection site (code).
E. Indicate injectionsite (code). ChartingCodes: A. CHARTEDIN ERROR. B. DRUG TEMPORALRYIUNAVAILABLE. C. RESIDENT REFUSED. D. DRUGHELD: IN NURSE’SJUDGEMENTDRUG INAPPROPRIATEOR NOT NEEDED AT THAT TIME.
E. RESIDENT VOMITED ORSPIT OUTMEDICATION. DOSAGEABSORBED QUESTIONABLE. F. RESIDENT OUT OFAFCILITY. G. SEE NURSE’S NOTES. H. DRUG HOLIADY.
DAY SHIFT color ink EVENING SHIFTcolor ink NIGHT SHIFT color ink DAY SHIFT color ink EVENING SHIFT color ink NIGHT SHIFT color ink
DATE / HOUR MEDICATION / DOSAGE ROUTE REASON INITIALS RESULTS/ RESPONSE SIGNATURE/INITIALS
Charitng Codes: A. CHARTED IN ERROR. B. DRUG TEMPORALRYIUNAVAILABLE. C. RESIDENT REFUSED. D. DRUG HELD: INNURSE’SJUDGEMENTDRUGINAPPROPRIATEORNOTNEEDEDAT THAT TIME. Charting Codes: A. CHARTED IN ERROR. B. DRUG TEMPORARILY UNAVAILABLE. C. RESIDENT REFUSED. D. DRUG HELD: IN NURSE’S JUDGEMENT DRUG INAPPROPRIATE OR NOT NEEDED AT THAT TIME.
E. RESIDENT VOMITEDOR SPITOUTMEDICATION. DOSAGE ABSORBED QUESTIONABLE. F. RESIDENT OUT OFAFCILITY. G. SEE NURSE’S NOTES. H. DRUG HOLIADY. E. RESIDENT VOMITED OR SPIT OUT MEDICATION. DOSAGE ABSORBED QUESTIONABLE. F. RESIDENT OUT OF FACILITY. G. SEE NURSE’S NOTES. H. DRUG HOLIDAY.

DATE / HOUR MEDICATION/ DOSAGE ROUTE REASON INITIALS RESULTS/ RESPONSE SIGNATURE/INITIALS DATE / HOUR MEDICATION / DOSAGE ROUTE REASON INITIALS RESULTS / RESPONSE SIGNATURE/INITIALS

SIGNATURE/INITIALS RESULTS/ RESPONSE INITIALS REASON ROUTE MEDICATION/ DOSAGE DATE / HOUR

RESULTS/ RESPONSE REASON ROUTE MEDICATION/ DOSAGE DATE / HOUR RESULTS / RESPONSE REASON ROUTE MEDICATION / DOSAGE DATE / HOUR H. DRUG HOLIADY. G. SEE NURSE’S NOTES. F. RESIDENT OUT OFFACILITY. E. RE ISDENTVOMITED ORSPIT OUT EMDICATION.DOSAGEABSORBED QUESTIONABLE. DAY SHIFT color ink
SIGNATURE/INITIALS INITIALS SIGNATURE/INITIALS INITIALS D. DRUG HELD: IN NURSE’S JUDGEMENT DRUG INAPPRAOTPERIOR NOT NEEDEATD THAT TIM .E C. RESIDENTREFUSED. B. DRUG TEMPORALRYIUNAVAILABLE. A. CHARTEDIN ERROR. Charting Codes:

G. SEE NURSE’S NOTES. H. DRUG HOLIADY. F. RESIDENT OUT OFFACILITY. E. RESIDENTVOMITED ORS IPTOUTMEDICATION. DOSAGE ABSORBED QUESTIONABLE. ChartingCodes: H. DRUG HOLIDAY. G. SEE NURSE’S NOTES. E. RESIDENT VOMITED OR SPIT OUT MEDICATION. DOSAGE ABSORBED QUESTIONABLE. F. RESIDENT OUT OF FACILITY. Charting Codes: NIGHT SHIFT color ink EVENING SHIFTcolor ink
D. DRUGHELD: IN NURSE’SJUDGEMENT DRUG INAPPRAOTPERIOR NOT NEEDEATD THAT TIM .E C. RE ISDENT REFUSED. B. DRUG TEMPORALRYIUNAVAILABLE. A. CHARTED INERROR. D. DRUG HELD: IN NURSE’S JUDGEMENT DRUG INAPPROPRIATE OR NOT NEEDED AT THAT TIME. C. RESIDENT REFUSED. A. CHARTED IN ERROR. B. DRUG TEMPORARILY UNAVAILABLE.

NIGHT SHIFT color ink EVENING SHIFTcolor ink DAY SHIFT color ink NIGHT SHIFT color ink EVENING SHIFT color ink DAY SHIFT color ink 15- Upper Chest Left 8- Left Deltoid Injection /Patch SiteCode: NURSE’S MEDIATCION NOTES
16- Upper Chest Right 9- Right Upper Arm 1- Right Dorsal Gluteus
15- Upper Chest Left 8- Left Deltoid Injection /PatchSiteCode: Res lut Codes: NURSE’S MEDIATCION NOTES 15- Upper Chest Left 8- Left Deltoid Injection/Patch Site Code: Result Codes: NURSE’S MEDICATION NOTES 17- To Right and Above Levelof Umbilicus 10- Left Upper Arm 2- Left Dorsal Gluteus Res lut Codes: Instrucitons:
16- Upper Chest Right 9- Right Upper Arm 1- Right Dorsal Gluteus 1. E ve Instru tcions: 16- Upper Chest Right 9- Right Upper Arm 1- Right Dorsal Gluteus 1. Effective Instructions: 18- To Left andAboveLevel of Umbilicus 11- Right Anterior Thigh 3- RightVentral Gluteus 1. E ve A. Put initials in appropriate boxwhen medication is given.
17- To Right and Above Levelof Umbilicus 10- Left Upper Arm 2- Left Dorsal Gluteus 2. Ine A. Put initials in appropriate box whenmedication is given. 17- To Right and Above Level of Umbilicus 10- Left Upper Arm 2- Left Dorsal Gluteus 2. Ineffective A. Put initials in appropriate box when medication is given. 19- To Right and Below Level of Umbilicus 12- Left Anterior Thigh 4- LeftVentral Gluteus 2. Ine B. Circle initials when medication isrefused.
18- To Left and AboveLevel of Umbilicus 11- Right Anterior Thigh 3- RightVentral Gluteus 3. Slightly E B. Circle initials when medication isrefused. 18- To Left and Above Level of Umbilicus 11- Right Anterior Thigh 3- Right Ventral Gluteus 3. Slightly Effective B. Circle initials when medication is refused. 20- To Left andBelow Level ofUmbilicus 13- Upper Back Left 5- Right Lateral Thigh 3. Slightly E C. Statereason forrefusalon Nurse’s Notes.
19- To Right and Below Level of Umbilicus 12- Left Anterior Thigh 4- LeftVentral Gluteus 4. No E C. Statereason forrefusalon Nurse’s Notes. 19- To Right and Below Level of Umbilicus 12- Left Anterior Thigh 4- Left Ventral Gluteus 4. No Effect Observed C. State reason for refusal on Nurse’s Notes. 14- Upper Back Right 6- Left Lateral Thigh 4. No E D. PRNmedication: Reasongiven should be noted on Nurse’s Notes.
20- To Left and Below Level ofUmbilicus 13- Upper Back Left 5- Right Lateral Thigh D. PRNmedication:Reasongiven should benoted on Nurse’s Notes. 20- To Left and Below Level of Umbilicus 13- Upper Back Left 5- Right Lateral Thigh D. PRN medication: Reason given should be noted on Nurse’s Notes. 7- Right Deltoid E. Indicate injection site (code).
14- Upper Back Right 6- Left Lateral Thigh E. Indicate injection site (code). 14- Upper Back Right 6- Left Lateral Thigh E. Indicate injection site (code).
7- Right Deltoid 7- Right Deltoid SIGNATURE & TITEL INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS

SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS

SIGNATURE & TITEL INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE BLOOD PRESSURE
INITIALS
SIGNATURE & TITEL INITIALS SIGNATURE & TITLE INITIALS SIGNATURE& TITLE BLOOD PRESSURE SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS SIGNATURE & TITLE INITIALS DATE DATE DATE DATE DATE DATE DATE
INITIALS
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 BLOOD PRESSURE
BLOOD PRESSEUR BLOOD PRESSURE
BLOOD PRESSURE
PAIN PAIN
WEIGHT TEMPERATURE WEIGHT PAIN TEMPERATURE
RESPIRATION PULSE RESPIRATION WEIGHT PULSE
PULSE PULSE RESPIRATION
TEMPERATURE RESPIRATION TEMPERATURE PULSE RESPIRATION
WEIGHT TEMPERATURE WEIGHT
MAR Backer PAIN MAR Backer PAIN
Dot Matrix Laser
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 DATE DATE DATE DATE DATE DATE DATE
TEMPERATURE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
PULSE
RESPIRATION

WEIGHT
PAIN

7 Day MAR Backer
Laser

800.235.0767 Shop more at integralsupplies.com/store/medication-records 







Stock # 501340 Statement and Envelopes
for Dot Matrix
RETURN SERVICE REQUESTED

Stock # 501341
for Dot Matrix

Stock # 501343 Stock # 501345
Self-Sealing for Laser for Laser

RETURN SERVICE REQUESTED Stock # 501349
for A/P and P/R Checks
Stock # 501344
for Laser

Stock # 705140 Stock # 705151

HCFA forms and envelopes are also available.

800.235.0767 Shop more at integralsupplies.com/store/statements-and-envelopes

Printer Supplies

We carry a full line of point of sale (POS) supplies for your store including paper rolls in thermal, single-ply
and multi-ply varieties. Our complete line of POS products include shelf labels, price stickers and credit
card receipts.
Additionally, we stock a variety of printer ribbons for Epson, IBM, Okidata, Zebra, Cognitive and compatible
printer ribbons.

Stock # 1-Ply Rolls Stock # 2-Ply Rolls
901100 3” x 165 ft 901099 3” x 100 ft
901102 2 3/4” x 190 ft
901096 3 1/8” x 230 ft, Thermal
901093 2 1/4” x 80 ft

INTEGRAL SOLUTIONS GROUP

Stock # 3 Part Credit Card Receipts Stock # Shelf Labels
901101 3 1/2” x 7 3/4” White 901097 2” x 1” Direct Thermal
901107 3 1/2” x 7 3/4” Yellow 901104 2” x 15/16” Laser Sheet

Stock # Price Stickers Stock # Shelf Label
901095 1.2” x .9” Direct Thermal 901098 2 1/4” x 1” Direct Thermal
901103 1 1/3” x 15/16” Laser Sheet

 Shop more at integralsupplies.com/store/printer-supplies www.integralsupplies.com

Printer Supplies

Stock # Zebra Thermal Ribbons Stock # Cognitive Ribbons
402450 4.33” x 1,476’ Wax 402452 4.25” x 458’ Wax
402451 4.33” x 242’ Wax 402454 4.25” x 459’ Resin
402453 4.33” x 242’ Resin

Stock # Epson Ribbons Stock # IBM Ribbons
402413 ERC-38 Black/Red 402415 Model 3 & 4 Black
402417 ERC-32 Black 402416 ERC-35 Black
402418 ERC-41 Purple
402419 ERC-43 Black

Stock # Okidata Ribbons Stock # Generic Ribbons
402425 380, 390, 391 301002 320, 321, 390, 391
402442 3410 301003 393, 395
402422 320, 321, 100 Series
402426 393, 395
402424 420, 421
402521 520, 521
402591 590, 591
402420 4410 Pacemark

800.235.0767 Shop more at integralsupplies.com/store/printer-supplies 

Printer Supplies

Integral Solutions Group carries a large selection of supplies for laser printers. We are an authorized
Lexmark reseller and stock both OEM and reconditioned toner cartridges in addition to other
brands.

Stock # Reconditioned Lexmark Stock # Compatible Lexmark
901177 T520, 522 901141 Optra S
901170 Optra S 901142 T520, 522
901171 T610, 612, 614, 616 901143 T610, 612, 614, 616
901172 T620, 622, X620 901144 T620, 622
901173 T632, 634, X632 901145 T630, 632, 634
901174 T640, 642, 644 901146 T640, 642, 644
901175 T630, 632, 634 901148 T650, 652, 654
901176 T650, 652, 654
901178 MS810, 811, 812 Our stock toners are high yield. Other
options are available.

Stock # OEM Lexmark Stock # Kyocera Toner
901115 C734, 736, 738 Black 901123 TK-60
901116 C734, 736, 738 Cyan
901117 C734, 736, 738 Magenta Many other brands and models are available.
901118 C734, 736, 738 Yellow
901122 T520, 522
901125 T630
901119 Optra S
901120 T610, 612, 614, 616
901121 T620, 622
901124 T632, 634
901126 T640, 642, 644
901131 T650, 652, 654
901132 MS810, 811, 812
901150 X642, 644, 646

 Shop more at integralsupplies.com/store/printer-supplies www.integralsupplies.com

Integral Benefits

Ordering Is Easy!

Call 800.235.0767 More Great Benefits
with ISG!
Fax 864.574.1315
FREE samples for most of our products;
www.integralsupplies.com is available 24/7 to request a sample packet today!
support your business.
Same day shipping on stock orders!

Knowledgeable Customer Service staff
available to answer your request!
M–F 8am – 5pm EST

Quality Products and Superior Service - that’s what Integral is all about. In
addition to top quality products, we offer these great benefits to all Integral customers:

• Reorder Reminder Program
• Order Consulting
• Same Day Shipping
• Online Ordering
• Free Storage for Custom Products

Integral Solutions Group is always open at www.integralsupplies.com.
Sign up today and take advantage of our online features:

• Specials - check out our promotions
• News / Events - stay informed
• New Products - see what’s new or changed
• Email Sign-Up - get important information delivered to your inbox
• Request For Quote - obtain a free estimate

800.235.0767 Shop more at integralsupplies.com 

PO Box 1412
Spartanburg SC 29304
800.235.0767
864.574.1315
www.integralsupplies.com
[email protected]



Printer Supplies

Integral Solutions Group carries a large selection of supplies for laser printers. We are an
authorized Lexmark reseller and stock both OEM and reconditioned toner cartridges in addition
to other brands.

Stock # Reconditioned Lexmark Stock # Compatible Lexmark Stock # OEM Lexmark Drum
901177 T520, 522 901141 Optra S 403603 MS810, 811, 812
901170 Optra S 901142 T520, 522 Lexmark
901171 T610, 612, 614, 616 901143 T610, 612, 614, 616 Wiper for S and T Series
901172 T620, 622, X620 901144 T620, 622
901173 T632, 634, X632 901145 T630, 632, 634
901174 T640, 642, 644 901146 T640, 642, 644
901175 T630, 632, 634 901148 T650, 652, 654
901176 T650, 652, 654
901178 MS810, 811, 812
Stock #
403606

Stock # Kyocera Developer
403605 TK-60

Stock # OEM Lexmark Stock # Kyocera Toner
901115 C734, 736, 738 Black 901123 TK-60
901116 C734, 736, 738 Cyan
901117 C734, 736, 738 Magenta
901118 C734, 736, 738 Yellow
901122 T520, 522
901125 T630
901119 Optra S
901120 T610, 612, 614, 616 Stock # Kyocera Toner Waste Bottle
901121 T620, 622 403604 TK-60
901124 T632, 634 Many other brands and models are available.
901126 T640, 642, 644
901131 T650, 652, 654
901132 MS810, 811, 812
901150 X642, 644, 646

47 www.integralsupplies.com