APPROVED FORMAT MEDICAL SCRIPTS Manufactured by Micro Format, Inc. |
Imprinting Information for New Jersey Laser Prescription Paper
and your Credit Card Payment Information will be requested
AFTER you have clicked on the "Add to Your SHOPPING CART" button
Due to State of New Jersey Regulations ~ Unimprinted forms are not available ~
When Requested,
Please accurately fill-in the information that needs to be imprinted on the top of each sheet.
Format #1 (MD,DO,DS,DMD,DPM,DVM) Each name must be imprinted with License # and NPI # |
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ENLARGE VIEW Item# NJMD2
To order ........
5,000 sheets $550.00 plus shipping by UPS 10,000 sheets $798.00 plus shipping by UPS |
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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"
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Item# NJNP2
To order ........
5,000 sheets $550.00 plus shipping by UPS 10,000 sheets $798.00 plus shipping by UPS |
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PA Format (Physician Assistant) New Jersey law requires only ONE Physician Assistant's name per script with ONE Collaborative Physician's name. |
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Item# NJPA2
To order ........
5,000 sheets $550.00 plus shipping by UPS 10,000 sheets $798.00 plus shipping by UPS |
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Format #2 (MEDICAL FACILITY) 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). |
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ENLARGE VIEW
Item# NJHC2
To order ........
5,000 sheets $550.00 plus shipping by UPS 10,000 sheets $798.00 plus shipping by UPS |
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Format #3 (OPTICIAN) Each name must be imprinted with License # and NPI # |
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ENLARGE VIEW
Item# NJOP2
To order ........
5,000 sheets $550.00 plus shipping by UPS 10,000 sheets $798.00 plus shipping by UPS |