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Secure LASER Prescription Paper - New Jersey Format
For NEW JERSEY prescription forms
Micro Format is a distributor for Prescription Pads and Laser Scripts.
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
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New Jersey Laser Prescription Forms
LASER DOCTOR (MD,DO,DS,DMD,DPM,DVM)
PRINTCO Imprinted Laser Prescription Paper meet all of the requirements legislated by the State of New Jersey.
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VERY IMPORTANT INFORMATION
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Before placing your order for FOUR per sheet Laser Scripts, confirm that your
Medical Records Software has the ability to print on the New Jersey FOUR PER PAGE Laser Format paper.
It was confirmed by a New Jersey Pharmacy Board Representative that
THERE IS NOTHING IN THE NEW JERSEY LAW that prohibits printing FOUR SCRIPTS PER SHEET.
When all four scripts are separated, unused scripts are valid for use as hand written prescriptions.
As with all prescriptions, it is your responsibility to secure all unused scripts.
It is YOUR CHOICE ...
You can order ONE script per sheet
or you can save money by ordering FOUR individually numbered scripts per sheet.
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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
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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 State Law requires that Micro Format maintains 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
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New Jersey Laser Prescription Forms
LASER DOCTOR
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 #
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ENLARGE VIEW
LaserDoctor-1
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
$480.00 plus shipping
by UPS
5,000 sheets
$800.00 plus shipping
by UPS
10,000 sheets
$1,500.00 plus shipping
by UPS
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QUESTIONS: Please send us an e-mail
support@prescriptionpaper.com
Copyright © 1995- Micro Format, Inc., All Rights Reserved
Micro Format, Inc.
830-3 Seton Court ~ Wheeling, IL 60090
Phone: 847/520-4699 ~ 800-333-0549
Fax 847/520-0197
rev 4/2017
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