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Secure LASER Prescription Paper - New Jersey Format

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.
Micro Format will begin accepting orders for all formats and versions of the revised New Jersey Rx forms on May 1st, 2014
THE FORMATS SHOWN BELOW ARE THE OLD FORMATS.
THE NEW REVISED FORMATS WILL BE AVAILABLE May 1, 2014

ORDER FORM secure

~This is a SECURE Order Form ~

Micro Format, Inc. along with our Manufacturing Partner Printco
is an approved NJ Pharmacy Board Security Prescription Paper Printer

Micro Format Imprinted Laser Prescription Paper
meet all of the requirements legislated by the State of New Jersey.

VERY IMPORTANT INFORMATION
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 on April 14, 2010 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.		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
This is a link to CURRENT NEW JERSEY LAW "NJPB Printing Specifications" are found on Page 4 section 13:45A-27.8
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 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# NJMD1
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
$479.00 plus shipping
by UPS

5,000 sheets
$715.00 plus shipping
by UPS

10,000 sheets
$1,177.00 plus shipping
by UPS

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

ENLARGE VIEW

Item# NJMD4
8" x 11"
Four Scripts per sheet
Script Size 4" x 5-1/2"

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

2,500 sheets
$534.00 plus shipping
by UPS

5,000 sheets
$770.00 plus shipping
by UPS

10,000 sheets
$1,232.00 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"

ENLARGE VIEW

Item# NJNP1
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
$479.00 plus shipping
by UPS

5,000 sheets
$715.00 plus shipping
by UPS

10,000 sheets
$1,177.00 plus shipping
by UPS

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

Item# NJNP4
8" x 11"
4 Scripts per Sheet
Script Size 4" x 5-1/2"

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

2,500 sheets
$534.00 plus shipping
by UPS

5,000 sheets
$770.00 plus shipping
by UPS

10,000 sheets
$1,232.00 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 #

ENLARGE VIEW

Item# NJPA1
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
$479.00 plus shipping
by UPS

5,000 sheets
$715.00 plus shipping
by UPS

10,000 sheets
$1,177.00 plus shipping
by UPS

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

Item# NJPA4
8" x 11"
4 Scripts per Sheet
Script Size 4" x 5-1/2"

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

2,500 sheets
$534.00 plus shipping
by UPS

5,000 sheets
$770.00 plus shipping
by UPS

10,000 sheets
$1,232.00 plus shipping
by UPS

New Jersey Laser Prescription Forms
Format #2 (MEDICAL FACILITY)
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).

ENLARGE VIEW

Item# NJHC1
Script Size 4" x 5-1/2"

8-1/2" x 11"
One Script-Top Left

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

2,500 sheets
$479.00 plus shipping
by UPS

5,000 sheets
$715.00 plus shipping
by UPS

10,000 sheets
$1,177.00 plus shipping
by UPS

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

ENLARGE VIEW

Item# NJHC4
8" x 11"
Four Scripts per sheet
Script Size 4" x 5-1/2"

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

2,500 sheets
$534.00 plus shipping
by UPS

5,000 sheets
$770.00 plus shipping
by UPS

10,000 sheets
$1,232.00 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# NJOP1
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
$479.00 plus shipping
by UPS

5,000 sheets
$715.00 plus shipping
by UPS

10,000 sheets
$1,177.00 plus shipping
by UPS

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

ENLARGE VIEW

Item# NJOP4
8" x 11"
Four Scripts per sheet
Script Size 4" x 5-1/2"

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

2,500 sheets
$534.00 plus shipping
by UPS

5,000 sheets
$770.00 plus shipping
by UPS

10,000 sheets
$1,232.00 plus shipping
by UPS

QUESTIONS: Please send us an e-mail
support@prescriptionpaper.com

Copyright © 2000-2014 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 7/2013