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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

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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

CheckboxHydrocodone Bitartrate 1mg/Homatropine 0.3mg/ml Oral Suspension (Vet-Beef)

Add

Adding

Radio 3

CheckboxHydrocodone Bitartrate 20 mg Oral Capsules

Add

Adding

Radio 3

CheckboxHyaluronic Acid 1%/Niacinamide 5% Topical Cream

Add

Adding

Radio 3

CheckboxHeparin Na 10K Units/Lidocaine HCl 80 mg/Na Bicarbonate 1 mg/50 mL Bladder Irrigation Liquid

Add

Adding

Radio 3

CheckboxHydrocodone Bitartrate 1mg/ml Oral Suspension (Vet-Beef)

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Tretinoin 0.1%/Urea 20% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 2.5%/Hydroquinone 4%/Tretinoin 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Retinoic Acid 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 0.042%/Minoxidil 2.4%/Progestoerone 0.5% Topical Liquid

Add

Adding

Radio 3

CheckboxHydrocodone Bitartrate 8 mg Oral Capsules

Add

Adding

Radio 3

CheckboxHydrochlorothiazide 5 mg/ml/Spironolactone 5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxHydroquinone 3%/Tretinoin 0.02% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 0.3%/Hydroquinone 6%/Kojic acid 3%/Tretinoin 1% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 0.1% Opthalmic Ointment

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Adding

Radio 3

CheckboxHydroquinone 5% Glycolic Acid 10% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 2%/Miconazole Nitrate 2% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Salicylic Acid 2% Otic Liquid

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Hydroquinone 8%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHydromorphone HCl 3 mg/Prochlorperazine Maleate 24.3 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHyaluronic Acid 1%/Kojic Acid 1%/Phytonadione 1% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Terbinafine 1% Otic Drops

Add

Adding

Radio 3

CheckboxHydrocortisone 0.75%/Hydroquinone 4.5%/Tretinoin 0.6% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Tretinoin 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 1.25%/Iodoquinol 1.25% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 1.3%/Tretinoin 0.03%/Triamcinolone 0.03% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 250 mg/60 mL Rectal Enema Liquid

Add

Adding

Radio 3

CheckboxHydroquinone 8%/Hydrocortisone 1%/Retinoic Acid 0.1%/Ascorbic Acid 0.5% Topical Ointment

Add

Adding

Radio 3

CheckboxHydrocortisone 2%/Hydroquinone 6%/Kojic Acid 3.2%/Salicylic Acid 4%/Tretinoin 0.01% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 8% Topical Ointment

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Retinoic Acid 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHyaluronic Acid 0.7% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 20 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxHaloperidol 10 mg Oral Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxHydromorphone HCl 4 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxHaloperidol 20 mg Oral Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxHydrocortisone 60 mg/Mesalamine 500 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 5% Topical Liquid Spray

Add

Adding

Radio 3

CheckboxHydrocortisone 50 mg/Neomycin 15 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHaloperidol 5 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Tretinoin 0.05%/Triamcinolone Acetonide 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 4%/Resorcinol 2%/Salicylic Acid 3%/Sulfur 2% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 8%/Kojic Acid 4%/Tretinoin 0.1% Topical Cream

Add

Adding

Radio 3

CheckboxHyaluronic Acid 0.7% Topical Serum

Add

Adding

Radio 3

CheckboxHydromorphone HCl 2 mg/ml Oral Liquid

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Adding

Radio 3

CheckboxHydrocortisone 1%/Mupirocin 2%/Nystatin 100/000 IU/g Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 6% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 15 mg/Lidocaine 75 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 3% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Mometasone Furoate 0.03% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Hydroquinone 6%/Kojic acid 3%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 25 mg/Lidocaine 111.11 mg/Nifedipine 5 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 2.5%/Ketoprofen 10%/Lidocaine HCl 5% Topical Gel

Add

Adding

Radio 3

CheckboxHaloperidol 0.5 mg/ml Transdermal Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 25 mg/Lidocaine 50 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 2%/Menthol 1% Topical Liquid Spray

Add

Adding

Radio 3

CheckboxHydroquinone 2%/Kojic acid 4%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Kojic Acid 8%/Tretinoin 0.025%/Triamcinolone Acetonide 0.025% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocodone Bitartrate 5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxHydroquinone 8%/Kojic Acid 4% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 10%/Tretinoin 0.1%/Triamcinalone Acetonide 0.1% Topical Cream

Add

Adding

Radio 3

CheckboxHydralazine HCl 10mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxHydrocortisone 2 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxHydrocortisone 2.5%/Salicylic Acid 4%/Sulfur 5% Topical Cream

Add

Adding

Radio 3

CheckboxHydrochlorothiazide 10 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxHydrocortisone 90 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Hydroquinone 4%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHydroxychloroquine Sulfate 25 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxHydrocortisone 2.5%/Lidocaine 5%/Nitoglycerin 0.2% Rectal Ointment

Add

Adding

Radio 3

CheckboxHydrocortisone 0.5%/Lidocaine HCl 5% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Hydroquinone 5%/Tretinoin 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxHaloperidol 2 mg/ml Transdermal Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 130 mg/Lidocaine HCl 195 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydromorphone HCl 0.625 mg Oral Troches

Add

Adding

Radio 3

CheckboxHydrocortisone 2%/Clotrimazole 2% Topical Cream

Add

Adding

Radio 3

CheckboxHaloperidol 5 mg/ml Transdermal Gel

Add

Adding

Radio 3

CheckboxHaloperidol 1 mg Oral Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxHydrocortisone 2%/Hydroquinone 6%/Kojic Acid 4%/Salicylic Acid 4%/Tretinoin 0.01% Topical Gel

Add

Adding

Radio 3

CheckboxHaloperidol 1 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Hydroquinone 6%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHydromorphone HCl 4 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 100 mg Vaginal Suppository

Add

Adding

Radio 3

CheckboxHaloperidol 2 mg Oral Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxHaloperidol 5 mg Oral Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxHyoscyamine Sulfate 0.112 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Hydroquinone 4%/Tretinoin 0.05% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Hydroquinone 8%/Kojic Acid 5%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 2%/Hydroquinone 4%/Tretinoin 0.03% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 1.25 mg/2.5 mg/5 mg Oral Capsules

Add

Adding

Radio 3

CheckboxHyoscyamine Sulfate 0.125 mg/Morphine Sulfate 7.5 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 10% Phonotophoresis Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 0.5%/Miconazole Nitrate 2% Topical Ointment

Add

Adding

Radio 3

CheckboxHydralazine HCl 10 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxHydroquinone 5%/Salicylic Acid 3% Topical Cream

Add

Adding

Radio 3

CheckboxHydroxychloroquine Sulfate 100 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxHydrocortisone 14 mg/Lidocaine 70 mg/Nifedipine 2.8 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxGentamicin Sulfate 25 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxGabapentin 10%/Ketoprofen 5% Transdermal Gel

Add

Adding

Radio 3

CheckboxGlycolic Acid 15% Topical Cream

Add

Adding

Radio 3

CheckboxGabapentin 5%/Ketoprofen 10%/Lidocaine 5% Transdermal Gel

Add

Adding

Radio 3

CheckboxGlutathione 250 mg Rectal Suppository

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

You may need to scale up or down your order form when printing to make it fit the page.

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