Secure LASER Prescription Paper - New Jersey Format
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.
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.
Laser MEDICAL FACILITY format
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.
to obtain the required signature document.
Please complete this document and send it by FAX to Micro Format, Inc.
New Jersey Laser Prescription Forms
Laser MEDICAL FACILITY-1
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).
Script Size 4" x 5-1/2"
8-1/2" x 11"
One Script-Top Left
LASER FACILITY FORMAT
We are required to imprint the Facility name,
facility license and bar code.
The balance of the information can be printed by the software.
For Prices and To Order
Call Micro Format Customer Service
QUESTIONS: Please send us an e-mail
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