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VERY IMPORTANT INFORMATION
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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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This is a link to
 CURRENT NEW JERSEY LAW
"NJPB Printing Specifications" are found on Page 4 section 13:45A-27.8
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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.
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New Jersey Laser Prescription Forms
Format #1 (MD,DO,DS,DMD,DPM,DVM)
Imprint up to 3 Names or 2 Names plus Facility Name.
Each name must be imprinted with License # and NPI #
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ONE SCRIPT PER SHEET
Approved NJ Script has a
unique consecutive number
as required by NJ Law.
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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"
Item# NJMD1
2,500 sheets
$435.00 plus shipping
by UPS
Item# NJMD1
5,000 sheets
$650.00 plus shipping
by UPS
Item# NJMD1
10,000 sheets
$1,070.00 plus shipping
by UPS
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New Jersey NP Laser Prescription Forms
Item# NJNP
Nurse Practitioner
Script Size 4" x 5-1/2"
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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
$435.00 plus shipping
by UPS
5,000 sheets
$650.00 plus shipping
by UPS
10,000 sheets
$1,070.00 plus shipping
by UPS
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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 #
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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
$435.00 plus shipping
by UPS
5,000 sheets
$650.00 plus shipping
by UPS
10,000 sheets
$1,070.00 plus shipping
by UPS
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