Continuity mistake: While J.D. and Carla are visiting Mrs Wilks near the start she has a tray of food and a bit of paper next to the tray in front of her. In shots of J.D. and Carla the table in front of Mrs Wilks where the food was is completely clear and the food and paper keep reappearing between shots.
Continuity mistake: Season 5-12 "My Cabbage": When Cox is explaining about the importancce of his "Clicky-top pen," he clicks it several times with his index finger. When the shot changes to over his shoulder, he is now clicking it with his thumb.
Answer: No, it was a fake, they used a stamp.
It is real.