www.NewJerseyRxPaper.com
www.NewJerseyPrescriptionPaper.com

  • Contact Us
  • Company Profile
  • 4securitypaper.com
  • PrescriptionPaper.com

  • Custom Imprinted
    Medical Prescription Scripts
    for use in the State of New Jersey

    For NEW JERSEY prescription forms
    Micro Format is a distributor for PRINTCO, INC.
    PRINTCO is a New Jersey approved manufacturer for NJ Prescription Pads


    NEW JERSEY SCRIPT REGULATIONS UPDATE

    The state of New Jersey has made changes to their prescription form program.
    The changes will improve the security of all New Jersey Rx forms by adding security features to reduce fraud.

    Click for additional details.
    PLACE YOUR ORDER TODAY.

    Order Form
    ~This is a SECURE Order Form ~

    PRINTCO Imprinted Prescription Pads
    meet all of the requirements legislated by the State of New Jersey.


    All Prescription Pad Orders MUST BE ENTERED ON LINE
    We cannot accept orders for prescription pads by Fax.
    =

    VERY IMPORTANT

    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 on behalf of Printco Inc., 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.

    Failure to send your License will delay the production of your order.

    NOTICE
    WITHOUT EXCEPTION,
    Your order WILL NOT BE PROCESSED until your License has been received.

    It is for your protection.

    We appreciate your co-operation with this requirement.
    New Jersey State Law requires that Micro Format on behalf of Printco, Inc., maintain on file the signature for each prescriber that appears on the script.
    If more than one prescriber appears, the RESPONSIBLE PRESCRIBER must be indicated.

    Please visit
    www.newjerseyrxpaper.com/FileSignature.pdf
    to obtain the required signature document.
    Please complete this document and send it by FAX to Micro Format, Inc.
    FAX# 847-520-0197


    Available Formats
    MD, DO, DS, DMD,
    DPM, DVM

    click to enlarge

    Physician Assistant


    click to enlarge


    Nurse Practitioner


    click to enlarge


    Facility Format


    click to enlarge


    Midwife


    click to enlarge


    Optometrist Format


    click to enlarge


    EYEWEAR


    click to enlarge


  • MD, DO, DS
    Click To Order
    2 part pads
  • PA
    Click To Order
    2 part pads
  • NP
    Click To Order
    2 part pads
  • FACILITY
    Click To Order
    2 part pads
  • MIDWIFE
    Click To Order
    2 part pads
  • OPTOMETRIST
    Click To Order
    2 part pads
  • EYEWEAR
    Click To Order
    2 part pads

  • Order 2 part pads Below

    MD, DO, DS, DMD, DPM, DVM
    Script Size: 4" x 5-1/2"
    Imprint up to 4 Names
    or 2 Names plus Facility Name
    Each name must be imprinted with License # and NPI #


    To Order ...
    click on the
    "Add to Your SHOPPING CART"
    button.

    MD, DO, DS, DMD, DPM, DVM
    TWO PART SCRIPTS
    50 sets per pad
    with wrap around cover
    Note: Part 2 is a
    BLANK YELLOW sheet

    20 pads (50 sets per pad) ~ 2 part ~ $10.75 per pad
    plus shipping
    by UPS

    40 pads (50 sets per pad) ~ 2 part ~ $8.25 per pad
    plus shipping
    by UPS

    80 pads (50 sets per pad ~ 2 part ~ $6.50 per pad
    plus shipping
    by UPS

    120 pads (50 sets per pad) ~ 2 part ~ $6.25 per pad
    plus shipping
    by UPS

    Physician Assistant
    Script Size: 4" x 5-1/2"


    click to enlarge

    If you are ordering the Physician Assistant format

    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.

    To Order ...
    click on the
    "Add to Your SHOPPING CART"
    button.

    Physician Assistant
    TWO PART SCRIPTS
    50 sets per pad
    with wrap around cover
    Note: Part 2 is a
    BLANK YELLOW sheet

    20 pads (50 sets per pad) ~ 2 part ~ $12.50 per pad
    plus shipping
    by UPS

    40 pads (50 sets per pad) ~ 2 part ~ $10.50 per pad
    plus shipping
    by UPS

    80 pads (50 sets per pad) ~ 2 part ~ $9.00 per pad
    plus shipping
    by UPS

    120 pads (50 sets per pad) ~ 2 part ~ $8.75 per pad
    plus shipping
    by UPS

    Nurse Practitioner
    Script Size: 4" x 5-1/2"


    click to enlarge

    If you are ordering the Nurse Practitioner format

    New Jersey law requires only ONE Nurse Practitioner's name per script with ONE Collaborative Physician's name.
    Both the Nurse Practitioner's name and information plus the Collaborative Physician's name and information must be pre-printed on script.

    To Order ...
    click on the
    "Add to Your SHOPPING CART"
    button.

    Nurse Practitioner
    TWO PART SCRIPTS
    50 sets per pad
    with wrap around cover
    Note: Part 2 is a
    BLANK YELLOW sheet

    20 pads (50 sets per pad) ~ 2 part ~ $12.50 per pad
    plus shipping
    by UPS

    40 pads (50 sets per pad) ~ 2 part ~ $10.50 per pad
    plus shipping
    by UPS

    80 pads (50 sets per pad) ~ 2 part ~ $9.00 per pad
    plus shipping
    by UPS

    120 pads (50 sets per pad) ~ 2 part ~ $8.75 per pad
    plus shipping
    by UPS

    Facility Format
    Script Size: 4" x 5-1/2"


    click to enlarge

    Imprint the Facility Name and Facility Number, Address and Phone Number.
    Only ONE LOCATION may appear on the front of the script.
    Additional locations may be printed on back of the script
    (at an additional charge).
    To Order ...
    click on the
    "Add to Your SHOPPING CART"
    button.

    Facility Format
    TWO PART SCRIPTS
    50 sets per pad
    with wrap around cover
    Note: Part 2 is a
    BLANK YELLOW sheet

    20 pads (50 sets per pad) ~ 2 part ~ $12.50 per pad
    plus shipping
    by UPS

    40 pads (50 sets per pad) ~ 2 part ~ $10.50 per pad
    plus shipping
    by UPS

    80 pads (50 sets per pad) ~ 2 part ~ $9.00 per pad
    plus shipping
    by UPS

    120 pads (50 sets per pad) ~ 2 part ~ $8.75 per pad
    plus shipping
    by UPS

    Midwife
    Script Size: 4" x 5-1/2"

    click to enlarge

    To Order ...
    click on the
    "Add to Your SHOPPING CART"
    button.

    Midwife
    TWO PART SCRIPTS
    50 sets per pad
    with wrap around cover
    Note: Part 2 is a
    BLANK YELLOW sheet

    20 pads (50 sets per pad) ~ 2 part ~ $12.50 per pad
    plus shipping
    by UPS

    40 pads (50 sets per pad) ~ 2 part ~ $10.50 per pad
    plus shipping
    by UPS

    80 pads (50 sets per pad) ~ 2 part ~ $9.00 per pad
    plus shipping
    by UPS

    120 pads (50 sets per pad) ~ 2 part ~ $8.75 per pad
    plus shipping
    by UPS

    Optometrist Format
    Script Size: 4" x 5-1/2"

    Imprint maximum 4 Names
    or 3 Names plus Facility Name.
    Each name must be imprinted with License # and NPI #


    click to enlarge

    To Order ...
    click on the
    "Add to Your SHOPPING CART"
    button.

    Optometrist Format
    TWO PART SCRIPTS
    50 sets per pad
    with wrap around cover
    Note: Part 2 is a
    BLANK YELLOW sheet

    20 pads (50 sets per pad) ~ 2 part ~ $12.50 per pad
    plus shipping
    by UPS

    40 pads (50 sets per pad) ~ 2 part ~ $10.50 per pad
    plus shipping
    by UPS

    80 pads (50 sets per pad) ~ 2 part ~ $9.00 per pad
    plus shipping
    by UPS

    120 pads (50 sets per pad) ~ 2 part ~ $8.75 per pad
    plus shipping
    by UPS

    EYEWEAR Format
    Script Size: 4" x 5-1/2"

    Imprint maximum 4 Names
    or 3 Names plus Facility Name.
    Each name must be imprinted with License # and NPI #


    click to enlarge

    To Order ...
    click on the
    "Add to Your SHOPPING CART"
    button.

    EYEWEAR Format
    TWO PART SCRIPTS
    50 sets per pad
    with wrap around cover
    Note: Part 2 is a
    BLANK YELLOW sheet

    20 pads (50 sets per pad) ~ 2 part ~ $12.50 per pad
    plus shipping
    by UPS

    40 pads (50 sets per pad) ~ 2 part ~ $10.50 per pad
    plus shipping
    by UPS

    80 pads (50 sets per pad) ~ 2 part ~ $9.00 per pad
    plus shipping
    by UPS

    120 pads (50 sets per pad) ~ 2 part ~ $8.75 per pad
    plus shipping
    by UPS


    Thank You for your order for Secure New Jersey Prescription Forms.
    We appreciate your business.
    Your order will ship in approximately 10 to 12 business days.
    Please allow up to 4 days for shipping by UPS.

    QUESTIONS: Please send us an e-mail support@rxpaper.com
    Copyright © 2004- Micro Format, Inc., All Rights Reserved
    Micro Format, Inc.
    830-3 Seton Court ~ Wheeling, IL 42090
    Phone: 847/520-4699 ~ 800-333-0549
    Fax 847/520-0197


    rev 04/2014