Home » Prescription Pads – New Jersey
Prescription Pads – New Jersey

Prescription Pads – New Jersey

Micro Format, Inc. is a distributor for Graphic Dimensions, Inc. Graphic Dimensions is a New Jersey Approved manufacturer for prescription pads and laser prescription paper.

Printed prescriptions take 7 to 10 business days for production.
New Jersey requires all prescriptions be shipped signature required to your address of record.
Before we can process any orders for prescriptions, we must receive a copy of your state medical license, this is the address we are required to ship to. We also need a completed Signature Form, which can be obtained by downloading the PDF. These forms can be returned to us at custserv@rxmicroformat.com

7 Products

  • New Jersey APN Pad Prescription form with yellow carbonless copy on a white background

    New Jersey APN Pad

    • This prescription pad is 4 x 5-1/2 inches.
    • New Jersey law requires only ONE Advance Practice Nurse's name per script with ONE Collaborative Physician's name. Both the Advance Practice Nurse's name and information plus the Collaborative Physician's name and information must be pre-printed on script.
    • This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
    • Back Printing available for an additional charge if additional addresses are desired.
    • All prescriptions in New Jersey must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
    • 10 Pads per Pack
    From $200.00
    View details
  • New Jersey Eyeware Pad Prescription form with yellow carbonless copy on a white background

    New Jersey Eyeware Pad

    • This prescription pad is 4 x 5-1/2 inches.
    • The format will fit five (5) lines of text, including the Practice Name, up to Three Providers and One Address, or Four Providers and no Practice Name.
    • This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
    • Back Printing available for an additional charge if additional addresses are desired.
    • Each Providers License and NPI must be pre-printed on the prescription. Please include this information in the imprint section, when placing order.
    • All prescriptions in New Jersey must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
    • 10 Pads per Pack
    From $200.00
    View details
  • New Jersey Facility Pad Prescription form with yellow carbonless copy on a white background

    New Jersey Facility Pad

    • This prescription pad is 4 x 5-1/2 inches.
    • This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
    • To use this format your facility must provide your state Healthcare Facility Number to be printed on the pad.
    • All prescriptions in New Jersey must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
    • 10 Pads per Pack
    From $200.00
    View details
  • New Jersey Medical Doctor Pad Prescription form with yellow carbonless copy on a white background

    New Jersey Medical Doctor Pad

    • This prescription pad is 4 x 5-1/2 inches.
      • The format will fit five (5) lines of text, including the Practice Name, up to Three Providers and One Address, or Four Providers and no Practice Name.
    • This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
    • Back Printing available for an additional charge if additional addresses are desired.
    • Each Providers License and NPI must be pre-printed on the prescription. Please include this information in the imprint section, when placing order.
    • All prescriptions in New Jersey must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
    • 10 Pads per Pack
    From $200.00
    View details
  • New Jersey Midwife Pad Prescription form with yellow carbonless copy on a white background

    New Jersey Midwife Pad

    • This prescription pad is 4 x 5-1/2 inches.
    • This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
    • Back Printing available for an additional charge if additional addresses are desired.
    • Each Providers License and NPI must be pre-printed on the prescription. Please include this information in the imprint section, when placing order.
    • All prescriptions in New Jersey must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
    • 10 Pads per Pack
    From $200.00
    View details
  • New Jersey OD Pad Prescription form with yellow carbonless copy on a white background

    New Jersey OD Pad

    • This prescription pad is 4 x 5-1/2 inches.
    • The format will fit five (5) lines of text, including the Practice Name, up to Three Providers and One Address, or Four Providers and no Practice Name.
    • This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
    • Back Printing available for an additional charge if additional addresses are desired.
    • Each Providers License and NPI must be pre-printed on the prescription. Please include this information in the imprint section, when placing order.
    • All prescriptions in New Jersey must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
    • 10 Pads per Pack
    From $200.00
    View details
  • New Jersey Physician Assistant Pad Prescription form with yellow carbonless copy on a white background

    New Jersey Physician Assistant Pad

    • This prescription pad is 4 x 5-1/2 inches.
    • New Jersey law requires only ONE Physician Assistant's name per script with ONE Supervising Physician's name. Both the Physician Assistant's name and information plus the Supervising Physician's name and information must be pre-printed on script.
    • This format is available as either a One-Part Script or a Two-Part Script: One-Part Pads have the secure prescription and contain 100 sheets per pad. Two-Part Pads have the secure prescription and a blank yellow carbonless copy. They contain 50 sets per pad and include a protective wrap-around cover.
    • Back Printing available for an additional charge if additional addresses are desired.
    • All prescriptions in New Jersey must be consecutively number, please select YES in the CONSECUTIVE NUMBERING box when asked.
    • 10 Pads per Pack
    $220.00
    View details