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Please Read ~ Important New Jersey Requirements
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Order 2 part pads Below
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ITEM# Format 1
(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 #
click to enlarge
To Order ...
click on the
"Add to Your SHOPPING CART"
button.
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PC41-NJ2
(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
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(MD, DO, DS, DMD, DPM, DVM)
WITH NUMBERING
20 pads ~ $10.75 per pad
plus shipping by UPS
40 pads ~ $8.65 per pad
plus shipping by UPS
80 pads ~ $7.65 per pad
plus shipping by UPS
160 pads ~ $7.45 per pad
plus shipping by UPS
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ITEM# Format2
(Facility Format)
Script Size: 4" x 5-1/2"
click to enlarge
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).
To Order ...
click on the
"Add to Your SHOPPING CART"
button.
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PC42-NJ2
(Facility Format)
TWO PART SCRIPTS
50 sets per pad
with wrap around cover
Note: Part 2 is a
BLANK YELLOW sheet
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(Facility Format)
WITH NUMBERING
20 pads ~ $10.75 per pad
plus shippingby UPS
40 pads ~ $8.65 per pad
plus shippingby UPS
80 pads ~ $7.65 per pad
plus shipping by UPS
160 pads ~ $7.45 per pad
plus shippingby UPS
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ITEM# Format3
(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.
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PC43-NJ2
(Optometrist Format)
TWO PART SCRIPTS
50 sets per pad
with wrap around cover
Note: Part 2 is a
BLANK YELLOW sheet
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(Optometrist Format)
WITH NUMBERING
20 pads ~ $10.75 per pad
plus shippingby UPS
40 pads ~ $8.65 per pad
plus shipping by UPS
80 pads ~$7.65 per pad
plus shipping by UPS
160 pads ~ $7.45 per pad
plus shippingby UPS
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ITEM# Format4
(Nurse Practitioner)
Script Size: 4" x 5-1/2"
click to enlarge
If you are ordering Format 4
(Nurse Practitioner)
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.
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PC44-NJ2
(Nurse Practitioner)
TWO PART SCRIPTS
50 sets per pad
with wrap around cover
Note: Part 2 is a
PRINTED YELLOW sheet
with no security features.
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20 pads ~ $10.75 per pad
plus shipping by UPS
40 pads ~ $8.65 per pad
plus shipping by UPS
80 pads ~ $7.65 per pad
plus shipping by UPS
160 pads ~$7.45 per pad
plus shipping by UPS
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ITEM# Format 5
(Physician's Assistant)
Script Size: 4" x 5-1/2"
click to enlarge
If you are ordering Format 5
(Physician's Assistant)
New Jersey law requires only ONE Physician's Assistant's name per script
with ONE Collaborative Physician's name.
Both the Physician's 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.
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PC48-NJ2
(Physician's Assistant)
TWO PART SCRIPTS
50 sets per pad
with wrap around cover
Note: Part 2 is a
PRINTED YELLOW sheet
with no security features.
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20 pads ~ $10.75 per pad
plus shipping by UPS
40 pads ~ $8.65 per pad
plus shipping by UPS
80 pads ~ $7.65 per pad
plus shippingby UPS
160 pads ~ $7.45 per pad
plus shippingby UPS
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