ePrescribe New Jersey LASER Prescription Paper

APPROVED LASER FORMAT
MEDICAL SCRIPTS for

www.RxPaper.com/Allscripts

Secure LASER Prescription Paper - New Jersey Format

Micro Format, Inc. along with our Manufacturing Partner Printco
is an approved NJ Pharmacy Board Security Prescription Paper Printer

Micro Format Imprinted Laser Prescription Paper
meet all of the requirements legislated by the State of New Jersey.

VERY IMPORTANT INFORMATION

When Requested,
Please accurately fill-in the information that needs to be imprinted on the top of each sheet.

NEW JERSEY LAW REQUIRES:

The License Number and NPI# to be printed for each doctor.
Only ONE LOCATION may appear on the front of the script.
All doctor's names MUST be printed on the front of the script.
The font "point size" can be no smaller than 7pt. Additional names MAY NOT be printed on the back of the script.
ADDITIONAL LOCATIONS may be printed on the back of the script at an additional charge of $45.00 per 1000.
New Jersey Law requires that all Rx Scripts be consecutively numbered

This is a link to
CURRENT NEW JERSEY LAW
"NJPB Printing Specifications" are found on Page 4 section 13:45A-27.8

IMPORTANT ORDER INFORMATION

New Jersey State Law requires that all Rx Paper Orders are shipped to the address on file with the State of New Jersey. After submitting your order - the Micro Format Compliance Department requires that you send a copy of your State License to our customer service department by FAX ~ FAX Number (847)520-0197
Orders will be processed ONLY after we have received a copy of your State License by Fax.
This insures that we are following New Jersey State Law.
State Law requires us to ship to the address as shown on your NJ License.
We appreciate your co-operation with this requirement.

New Jersey Laser Prescription Forms
Format #1 (MD,DO,DS,DMD,DPM,DVM)
Imprint up to 4 Names or 2 Names plus Facility Name
Each name must be imprinted with License # and NPI #

ENLARGE VIEW
Item# NJMD1
8-1/2" x 11"
One Script-Top Left
Script Size 4" x 5-1/2"
To order ........
Click On
"Add to Shopping Cart"

2,500 sheets
$479.00 plus shipping
by UPS

5,000 sheets
$715.00 plus shipping
by UPS

10,000 sheets
$1,177.00 plus shipping
by UPS

New Jersey NP Laser Prescription Forms
Use this format when ordering the Midwife Format;
In comment section of order form note "Midwife"
Item# NJNP
Nurse Practitioner
Script Size 4" x 5-1/2"

ENLARGE VIEW
Item# NJNP1
8-1/2" x 11"
One Script-Top Left
Script Size 4" x 5-1/2"
To order ........
Click On
"Add to Shopping Cart"

2,500 sheets
$479.00 plus shipping
by UPS

5,000 sheets
$715.00 plus shipping
by UPS

10,000 sheets
$1,177.00 plus shipping
by UPS

New Jersey Laser Prescription Forms
PA Format (Physician Assistant)

New Jersey law requires only ONE Physician Assistant's name per script with ONE Collaborative Physician's name.
Both the Physician Assistant's name and information plus the Collaborative Physician's name and information must be pre-printed on script. Must be imprinted with License # and NPI #

ENLARGE VIEW
Item# NJPA1
8-1/2" x 11"
One Script-Top Left
Script Size 4" x 5-1/2"
To order ........
Click On
"Add to Shopping Cart"

2,500 sheets
$479.00 plus shipping
by UPS

5,000 sheets
$715.00 plus shipping
by UPS

10,000 sheets
$1,177.00 plus shipping
by UPS

New Jersey Laser Prescription Forms
Format #2 (MEDICAL FACILITY)
Imprint the Facility Name, Address and Phone Number. Only ONE LOCATION may appear
on the front of the script. One Doctor's Name, NPI# and License Number must appear on script.
Additional locations may be printed on back of the script
(at an additional charge).

ENLARGE VIEW
Item# NJHC1
Script Size 4" x 5-1/2"
8-1/2" x 11"
One Script-Top Left
To order ........
Click On
"Add to Shopping Cart"

2,500 sheets
$479.00 plus shipping
by UPS

5,000 sheets
$715.00 plus shipping
by UPS

10,000 sheets
$1,177.00 plus shipping
by UPS

New Jersey Laser Prescription Forms
Format #3 (OPTICIAN)
Imprint maximum 4 Names or 3 Names plus Facility Name.
Each name must be imprinted with License # and NPI #

ENLARGE VIEW
Item# NJOP1
8-1/2" x 11"
One Script-Top Left
Script Size 4" x 5-1/2"
To order ........
Click On
"Add to Shopping Cart"

2,500 sheets
$479.00 plus shipping
by UPS

5,000 sheets
$715.00 plus shipping
by UPS

10,000 sheets
$1,177.00 plus shipping
by UPS

QUESTIONS: Please send us an e-mail
support@prescriptionpaper.com

Copyright © 2007-2013 inclusive
Micro Format, Inc
All Rights Reserved
Micro Format, Inc.
830-3 Seton Court ~ Wheeling, IL 60090
847/520-4699 FAX 847/520-0197
800-333-0549

rev 07/2013