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1

Search for medications or formulations to prescribe.

2

Click Order Medication and fill out order form.

3

Print and fax it to the pharmacy at 401-284-4506.

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Visit the Tutorials tab to learn more.

First

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1

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Patient Information

Last Name

First Name

MI

Address

Apt. #

City

State

ZIP

Phone #

Date of Birth

Sex

Male

Female

Email

Patient will pick up at pharmacy

Please ship to patient

Please ship to office

2

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Prescriber and Prescription Information

Prescriber's First Name

Prescriber's Last Name

Phone Number

Fax Number

Address

City

State

ZIP

NPI/DEA

Add

Adding

Radio 3

CheckboxPilocarpine HCl 5 mg Oral Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxPimobendan 5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxOxytocin 25 IU/mL Nasal Spray

Add

Adding

Radio 3

CheckboxPhenytoin Sodium 100 mg Oral Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxPerindopril Erbumine 8 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxPhenobarbital 100 mg/ml Transdermal Gel

Add

Adding

Radio 3

CheckboxPodophyllum Resin 25% in Tincture of Benzoin Topical Liquid

Add

Adding

Radio 3

CheckboxPilocarpine HCl 2% Oral Rinse

Add

Adding

Radio 3

CheckboxOxytocin 40 IU/mL Nasal Spray

Add

Adding

Radio 3

CheckboxPhytonadione 25 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxPanthenol 3% Topical Cream

Add

Adding

Radio 3

CheckboxPotassium Iodide 65 mg Oral Capsules

Add

Adding

Radio 3

CheckboxPiroxicam 5 mg Oral Capsules

Add

Adding

Radio 3

CheckboxPravastatin Sodium 1 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxPilocarpine HCl 1mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxOxycodone HCl 2.5 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxOxybutynin Chloride 10% Topical Gel

Add

Adding

Radio 3

CheckboxPotassium Iodide 65 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxPhenoxybenzamine HCl 15 mg/ml Transdermal Cream

Add

Adding

Radio 3

CheckboxPhenytoin Sodium 60 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxProbenecid 100 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPregnenolone 50 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxOxytocin 50 IU/g Vaginal Cream

Add

Adding

Radio 3

CheckboxPovidone-Iodine 2%/DMSO 20% Topical Gel

Add

Adding

Radio 3

CheckboxProgesterone 0.125%/Testosterone 6% Topical Liquid

Add

Adding

Radio 3

CheckboxPraziquantel 600 mg Oral Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxPropylthiouracil 5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxPhenylephrine HCl 10% Rectal Ointment

Add

Adding

Radio 3

CheckboxPropafenone HCl 37.5 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxPolidocanol 1.667% Topical Ointment

Add

Adding

Radio 3

CheckboxPrimidone 250 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxPentoxifylline 3%/Tamoxifen Citrate 0.152%/Retinoic Acid 0.05% Topical Cream

Add

Adding

Radio 3

CheckboxPentoxifylline 25 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxPraziquantel 300 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxParomomycin 200 mg/5 mL Oral Liquid Flavored

Add

Adding

Radio 3

CheckboxOxytocin 125 IU/Tadalafil 20 mg Oral Capsules

Add

Adding

Radio 3

CheckboxPhenylpropanolamine HCl 12.5 mg Oral Capsules (Vet)

Add

Adding

Radio 3

CheckboxPotassium Gluconate 2 mEq/2 mL Oral Liquid

Add

Adding

Radio 3

CheckboxPotassium Iodide 19% Topical Liquid

Add

Adding

Radio 3

CheckboxPregnenolone 20 mg/g Topical Cream

Add

Adding

Radio 3

CheckboxPiroxicam 10 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxPregnenolone 9 mg/0.1 mL Oral Sublingual Drops

Add

Adding

Radio 3

CheckboxPregabalin 50 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxPergolide mesylate 1 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxPhenobarbital 16 mg/ml Oral Oil Liquid

Add

Adding

Radio 3

CheckboxPhenytoin Sodium 200 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxOrphenadrine Citrate 5%/Tetracaine 2%/Tramadol HCl 5% Topical Gel

Add

Adding

Radio 3

CheckboxPhenylephrine HCL 0.5%/Tetracaine HCL 2.276% Nasal Spray

Add

Adding

Radio 3

CheckboxPentoxifylline 20 mg/Verapamil HCl 100 mg/g Topical Gel

Add

Adding

Radio 3

CheckboxNiacinamide 4%/Tretinoin 0.035% Topical Cream

Add

Adding

Radio 3

CheckboxNifedipine 8% Transdermal Gel

Add

Adding

Radio 3

CheckboxNitroglycerin 0.2% Rectal Ointment

Add

Adding

Radio 3

CheckboxNystatin 500 000 IU Slow Release (MEM4) Oral Capsules

Add

Adding

Radio 3

CheckboxNeomycin 250 mg Oral Capsules

Add

Adding

Radio 3

CheckboxNaloxone 2 mg/ml/Oxycodone 30 mg/ml Oral Sublingual Drops

Add

Adding

Radio 3

CheckboxNystatin 1.6 MU Oral Capsules

Add

Adding

Radio 3

CheckboxNicotinamide Adenine Dinucleotide Oxidized 333 mg/ml Nasal Spray

Add

Adding

Radio 3

CheckboxOmeprazole 2 mg/ml Gastric Tube Liquid

Add

Adding

Radio 3

CheckboxOmeprazole 3 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxNifedipine 0.3%/Lidocaine 1.0% Rectal Ointment

Add

Adding

Radio 3

CheckboxNaproxen Sodium 20% Transdermal Cream

Add

Adding

Radio 3

CheckboxOmeprazole 5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxNifedipine 10 mg Sublingual Troches

Add

Adding

Radio 3

CheckboxNiacinamide 3% Topical Cream

Add

Adding

Radio 3

CheckboxNystatin 100/000 U Oral Popsicles

Add

Adding

Radio 3

CheckboxNiacinamide 5%/Tretinoin 0.1% Topical Cream

Add

Adding

Radio 3

CheckboxNystatin 10/000 IU/mL Otic Liquid

Add

Adding

Radio 3

CheckboxNaloxone HCl 1 mg/Oxycodone HCl 100 mg Slow Release (MEM4) Oral Capsules

Add

Adding

Radio 3

CheckboxNystatin 3000 IU/Zinc Oxide 0.75% Topical Cream

Add

Adding

Radio 3

CheckboxNADH 5 mg Oral Capsules

Add

Adding

Radio 3

CheckboxNitrofurantoin 12.5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMupirocin 2%/Vancomycin 5% Topical Ointment

Add

Adding

Radio 3

CheckboxNiacinamide 3%/Sulfacetamide Sodium 10%/Sulfur 5% Topical Wash

Add

Adding

Radio 3

CheckboxMupirocin 1% Nasal Spray

Add

Adding

Radio 3

CheckboxNiacinamide 4%/Sodium Hyaluronate 1% Topical Serum

Add

Adding

Radio 3

CheckboxNiacinamide 2%/Tretinoin 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxOmeprazole 20 mg/5 mL Gastric Tube Liquid

Add

Adding

Radio 3

CheckboxNeomycin 100 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxNicotinamide Adenine Dinucleotide Oxidized 300 mg/ml Nasal Spray

Add

Adding

Radio 3

CheckboxNaltrexone HCL 3 mg/ml Transdermal Gel

Add

Adding

Radio 3

CheckboxNitroglycerin 0.125% Topical Ointment

Add

Adding

Radio 3

CheckboxNicotinamide Adenine Dinucleotide Oxidized 100 mg Oral Capsules

Add

Adding

Radio 3

CheckboxNicotinamide Adenine Dinucleotide Oxidized 25 mg/0.1 mL Nasal Spray

Add

Adding

Radio 3

CheckboxNiacinamide 5% Topical Serum

Add

Adding

Radio 3

CheckboxOlmesartan Medoxomil 10 mg/2.5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxOndansetron HCl 5 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxOndansetron 4 mg/Prochlorperazine 25 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxMupirocin 10 mg Vaginal Suppository

Add

Adding

Radio 3

CheckboxNaproxen 500 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxNitroglycerin 4 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxNaproxen Sodium 10% Transdermal Gel

Add

Adding

Radio 3

CheckboxNiacinamide 100 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxMupirocin 2% Nasal Ointment

Add

Adding

Radio 3

CheckboxNifedipine 5 mg/2.5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxNifedipine 0.5% Rectal Ointment

Add

Adding

Radio 3

CheckboxOlanzapine 2.5 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxMupirocin 0.5 mg/ml Nasal Spray

Add

Adding

Radio 3

CheckboxNitrofurazone 0.2% Topical Liquid

Add

Adding

Radio 3

CheckboxNeomycin 25 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxNizatidine 15 mg/ml Oral Liquid

Directions:

QTY:

Refills

1

2

3

4

5

6

7

8

9

10

xPrescriber's Signature:

Date

3

Circle for steps.

Fill out the Pharmacy Name and Fax Number, then fax it to the Pharmacy.

Pharmacy Name

Pharmacy Fax Number

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Thank you! Your submission has been received!

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