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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.

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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

Circle for steps.

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

CheckboxMinocycline 2% Oral Gel

Add

Adding

Radio 3

CheckboxMinoxidil 7%/Tretinoin 0.01% Topical Liquid

Add

Adding

Radio 3

CheckboxMethotrexate 0.5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMinoxidil 1 mg Oral Capsules

Add

Adding

Radio 3

CheckboxMiconazole 8% Topical Nail Tincture Liquid

Add

Adding

Radio 3

CheckboxMirtazapine 2 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMetronidazole 1%/Niacinamide 3%/Panthenol 1%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxMontelukast Sodium 4.16 mg/3 mL Oral Liquid

Add

Adding

Radio 3

CheckboxMinoxidil 9% Topical Liquid

Add

Adding

Radio 3

CheckboxMethylprednisolone Acetate 0.1%/Tetracycline HCl 0.5% Topical Ointment

Add

Adding

Radio 3

CheckboxMinoxidil 5%/Spironolactone 5% Topical Foam

Add

Adding

Radio 3

CheckboxMidazolam 0.5 mg Oral Troches

Add

Adding

Radio 3

CheckboxMinoxidil 0.25 mg/Spironolactone 25 mg Oral Capsules

Add

Adding

Radio 3

CheckboxMisoprostol 1000 mcg Rectal Suppository

Add

Adding

Radio 3

CheckboxMiconazole 2% Oral Gel

Add

Adding

Radio 3

CheckboxMinoxidil 7%/Tretinoin 0.1% Topical Foam

Add

Adding

Radio 3

CheckboxMetronidazole 50 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMethylcobalamin 1/000 mcg/mL Oral Sublingual Drops

Add

Adding

Radio 3

CheckboxMiconazole Nitrate 1% Otic Liquid

Add

Adding

Radio 3

CheckboxMagnesium Chloride 200 mg/ml Topical Liquid

Add

Adding

Radio 3

CheckboxMagnesium Glycinate 250 mg Oral Capsules

Add

Adding

Radio 3

CheckboxMercaptopurine 10 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxLysine HCl 250 mg/1.25 mL Oral Gel

Add

Adding

Radio 3

CheckboxMeloxicam 30 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMagnesium Glycinate 500 mg Oral Capsules

Add

Adding

Radio 3

CheckboxMesalamine 1000 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxMeperidine HCl 100 mg Oral Capsules

Add

Adding

Radio 3

CheckboxMethazolamide 50 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxMedroxyprogesterone Acetate 1% Ophthalmic Liquid

Add

Adding

Radio 3

CheckboxMeloxicam 1.5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMetformin HCL 100 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMeclizine HCl 0.1% Oral Liquid

Add

Adding

Radio 3

CheckboxMequinol 2%/Tretinoin 0.01% Topical Liquid

Add

Adding

Radio 3

CheckboxMagnesium Glycinate 200 mg/ml Transdermal Gel

Add

Adding

Radio 3

CheckboxMeloxicam 0.3%/Tizanidine HCl 0.2% Topical Cream

Add

Adding

Radio 3

CheckboxMesalamine 250 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxMagnesium Glycinate 200 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMagnesium Glycinate 200 mg/Melatonin 3 mg/Theanine 250 mg Oral Capsules

Add

Adding

Radio 3

CheckboxMagnesium Chloride 1 mg/mL Oral Liquid

Add

Adding

Radio 3

CheckboxMethenamine Mandelate 500 mg/5 mL Gastric Tube Liquid

Add

Adding

Radio 3

CheckboxMagnesium Glycinate 200 mg/ml Topical Cream

Add

Adding

Radio 3

CheckboxMeloxicam 1 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMetformin HCl 50 mg/ml Transdermal Gel

Add

Adding

Radio 3

CheckboxMagnesium Chloride 5% Transdermal Gel

Add

Adding

Radio 3

CheckboxMeloxicam 5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMagnesium Glycinate 5%/Melatonin 0.02% Topical Cream

Add

Adding

Radio 3

CheckboxMandelic Acid 40% Topical Liquid

Add

Adding

Radio 3

CheckboxMenthol 0.1%/Salicylic Acid 3% Topical Liquid

Add

Adding

Radio 3

CheckboxMenthol 3.5% Topical Gel

Add

Adding

Radio 3

CheckboxMenthol 2% Topical Ointment

Add

Adding

Radio 3

CheckboxMagnesium Glycinate 500 mg/Melatonin 5 mg Oral Capsules

Add

Adding

Radio 3

CheckboxManganese Sulfate 4 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMesalamine 50 mg/ml Rectal Gel

Add

Adding

Radio 3

CheckboxMesalamine 50 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxMethenamine Hippurate 250 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxMeclizine HCl 50 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxMagnesium Oxide 840 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxMagnesium Sulfate Heptahydrate 5.07 g/10 mL Gastric Tube Liquid

Add

Adding

Radio 3

CheckboxMethadone HCl 20 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxMagnesium Glycinate 375 mg/Pyridoxine HCl 17 mg Oral Capsules

Add

Adding

Radio 3

CheckboxMeloxicam 3 mg Oral Tablets

Add

Adding

Radio 3

CheckboxMesalamine 500 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxMandelic Acid 30% Topical Gel

Add

Adding

Radio 3

CheckboxMagnesium Chloride 300 mg/ml Topical Liquid

Add

Adding

Radio 3

CheckboxMagnesium Chloride 10% Topical Cream

Add

Adding

Radio 3

CheckboxMeloxicam 3 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxGentamicin 5.33 mg/ml Bladder Irrigation Solution

Add

Adding

Radio 3

CheckboxGentamicin 0.48 mg/ml Bladder Irrigation Solution

Add

Adding

Radio 3

CheckboxGentamicin 0.8 mg/ml Bladder Irrigation Solution

Add

Adding

Radio 3

CheckboxGentamicin 1.3 mg/ml Bladder Irrigation Solution

Add

Adding

Radio 3

CheckboxGentamicin 0.4 mg/ml Bladder Irrigation Solution

Add

Adding

Radio 3

CheckboxSirolimus 0.2% Topical Liquid

Add

Adding

Radio 3

CheckboxSirolimus 0.1% Topical Ointment

Add

Adding

Radio 3

CheckboxSirolimus 1% Topical Cream

Add

Adding

Radio 3

CheckboxSirolimus 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxSirolimus 0.5% Topical Ointment

Add

Adding

Radio 3

CheckboxSirolimus 0.1 mg/g Topical Cream

Add

Adding

Radio 3

CheckboxLidocaine 4%/Tetracaine 2% Topical Ointment

Add

Adding

Radio 3

CheckboxLisinopril 20 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxLactic Acid 18%/Salicylic Acid 18%/Trichloroacetic Acid 12% Topical Liquid

Add

Adding

Radio 3

CheckboxLevofloxacin Hemihydrate 20.5 mg/ml Nasal Irrigation

Add

Adding

Radio 3

CheckboxLactic Acid 2% Topical Gel

Add

Adding

Radio 3

CheckboxLidocaine HCl 2%/Tea Tree Oil 5% Topical Lotion

Add

Adding

Radio 3

CheckboxLevothyroxine Sodium 112 mcg/Liothyronine 28 mcg Oral Capsules

Add

Adding

Radio 3

CheckboxKetorolac Tromethamine 3% Topical Cream

Add

Adding

Radio 3

CheckboxLovastatin Potassium 40 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxLipoic Acid 300 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxLidocaine 2.5%/Salicylic Acid 5% Topical Gel

Add

Adding

Radio 3

CheckboxLevothyroxine Sodium 10.9 mcg/Liothyronine 3.3 mcg Slow Release (MEM4) Oral Capsules

Add

Adding

Radio 3

CheckboxLiothyronine 25 mcg/mL Oral Liquid

Add

Adding

Radio 3

CheckboxLidocaine 2%/Nifedipine 0.2% Rectal Ointment

Add

Adding

Radio 3

CheckboxLidocaine HCl 10% Topical Lotion

Add

Adding

Radio 3

CheckboxLevetiracetam 300 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxLansoprazole 6 mg/ml Gastric Tube Liquid

Add

Adding

Radio 3

CheckboxLansoprazole 3 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxLidocaine 7%/Prilocaine HCL 7% Topical Cream

Add

Adding

Radio 3

CheckboxLiothyronine 2 mcg Oral Capsules

Add

Adding

Radio 3

CheckboxLevothyroxine Sodium 48 mcg/Liothyronine 12 mcg Slow Release (MEM4) Oral Capsules

Add

Adding

Radio 3

CheckboxLiothyronine 30 mcg Slow Release (MEM4) Oral Capsules

Add

Adding

Radio 3

CheckboxLactic Acid 5%/Urea 10% Topical Cream

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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