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    New Jersey Formats

    EFFECTIVE NOVEMBER 4, 2014
    Prescribers must use new versions for all Scripts written 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 Prescription Pads and Laser Scripts.


    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.


    Printco Imprinted Laser Prescription Paper
    meets all of the requirements legislated by the State of New Jersey.

    VERY IMPORTANT INFORMATION
    When Requested as you fill in your order,
    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
    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



    New Jersey Laser Prescription Formats
    Click on Laser Format Required

    LASER Doctor

    MD, DO, DS, DMD,
    DPM, DVM

    LASER Physician Assistant

    PA

    LASER Nurse Practitioner

    NP

    LASER Facility Format

    Facility

    LASER Midwife Format

    Midwife

    LASER Optometrist Format

    Optometrist

    EyeWear Format

    EyeWear

    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