Acrendo Software
APPROVED FORMAT
MEDICAL SCRIPTS

Manufactured by Micro Format, Inc.
www.RxPaper.com/acrendo

NEW JERSEY APPROVED FORMATS
LASER MEDICAL SCRIPTS

For Doctors, Healthcare Professionals & Medical Clinics

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.




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# NJMD2
4" x 11"
Two Scripts
Over/Under
Script Size 4" x 5-1/2"

To order ........
Click On
"Add to Shopping Cart"


5,000 sheets
$550.00 plus shipping
by UPS

10,000 sheets
$798.00 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"


Item# NJNP2
4" x 11"
Two Scripts
Over/Under
Script Size 4" x 5-1/2"

To order ........
Click On
"Add to Shopping Cart"


5,000 sheets
$550.00 plus shipping
by UPS

10,000 sheets
$798.00 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 #


Item# NJPA2
4" x 11"
Two Scripts
Over/Under
Script Size 4" x 5-1/2"

To order ........
Click On
"Add to Shopping Cart"


5,000 sheets
$550.00 plus shipping
by UPS

10,000 sheets
$798.00 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# NJHC2
4" x 11"
Two Scripts
Over/Under
Script Size 4" x 5-1/2"

To order ........
Click On
"Add to Shopping Cart"


5,000 sheets
$550.00 plus shipping
by UPS

10,000 sheets
$798.00 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# NJOP2
4" x 11"
Two Scripts
Over/Under
Script Size 4" x 5-1/2"

To order ........
Click On
"Add to Shopping Cart"


5,000 sheets
$550.00 plus shipping
by UPS

10,000 sheets
$798.00 plus shipping
by UPS

E-Mail: Questions send us an e-mail ~ Support@4securitypaper.com
Copyright © 2003-2013 Micro Format, Inc. ~ All Rights Reserved
4securitypaper.com
a division of
Micro Format, Inc.
830-3 Seton Court ~ Wheeling, IL 60090
Phone: 847/520-4699 ~ 800-333-0549
Fax 847/520-0197


rev 07/2013