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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

Circle for steps.

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

CheckboxClonidine HCl 0.5%/Dicofenac Sodium 5%/Diltiazem HCl 4%/Gabapentin 6%/Ketamine HCL 8%/Lidocaine 8% Transdermal Gel

Add

Adding

Radio 3

CheckboxCisapride 2.5 mg Oral Capsules (Vet)

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Adding

Radio 3

CheckboxClorazepate Dipotassium 3.75 mg/ml Oral Liquid

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Adding

Radio 3

CheckboxCyclobenzaprine hydrochloride 2 mg/ml Oral Liquid

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Adding

Radio 3

CheckboxCoal Tar Solution 8%/Salicylic Acid 4% Topical Liquid

Add

Adding

Radio 3

CheckboxCiprofloxacin 0.3%/Dexamethasone 0.125% Otic Liquid

Add

Adding

Radio 3

CheckboxChrysin 5% Topical Cream

Add

Adding

Radio 3

CheckboxChrysin 10% Topical Cream

Add

Adding

Radio 3

CheckboxChlorpromazine 50 mg/ml Rectal Gel

Add

Adding

Radio 3

CheckboxChloriazepoxide HCl 1 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxCiclopirox Olamine 6% Topical Cream

Add

Adding

Radio 3

CheckboxChrysin 15 mg/Testosterone 125 mg/ml Topical Gel

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 2%/Miconazole Nitrate 2% Topical Liquid

Add

Adding

Radio 3

CheckboxCiprofloxacin 0.3%/Dexamethasone 0.075% Otic Liquid

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Adding

Radio 3

CheckboxChrysin 5%/DHEA 1.5%/Progesterone 0.8%/Testosterone 5% Topical Cream

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 0.5% Topical Cream

Add

Adding

Radio 3

CheckboxChrysin 20% Topical Cream

Add

Adding

Radio 3

CheckboxCiclopirox 3.52%/Fluconazole 3%/Ibuprofen 2%/Itraconazole 3%/Terbinafine HCl 1% Topical Nail Liquid

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 2% Topical Lotion

Add

Adding

Radio 3

CheckboxCimetidine 2%/Deoxy Glucose 0.2%/Fluorouracil 5%/Imiquimod 2.5%/Salicylic Acid 40% Topical Cream

Add

Adding

Radio 3

CheckboxCimetidine 4% Topical Gel

Add

Adding

Radio 3

CheckboxCimetidine 5%/Deoxy-D-Glucose 0.2%/Ibuprofen 2%/Tea Tree Oil 10% Topical Gel

Add

Adding

Radio 3

CheckboxCimetidine 15 mg/0.1 mL Oral Liquid

Add

Adding

Radio 3

CheckboxChrysin 15% Topical Cream

Add

Adding

Radio 3

CheckboxChlorpheniramine Maleate 2 mg/ml/Methscopolamine Nitrate 0.325 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxCholesterol 150 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxChloramphenicol 0.5%/Salicylic Acid 2% Topical Liquid

Add

Adding

Radio 3

CheckboxChloroacetic Acid 80% Topical Liquid

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 0.12% Wound Cleanser Liquid

Add

Adding

Radio 3

CheckboxCimetidine 5%/Ibuprofen 2%/Salicylic Acid 60%/Trichloroacetic Acid 1% Topical Paste

Add

Adding

Radio 3

CheckboxChloramphenicol 4.2 mg/ml/Prednisone 1.7 mg/Tetracaine HCL 4.2 mg/ml Otic Liquid

Add

Adding

Radio 3

CheckboxChlorpheniramine Maleate 0.4 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxCholesterol 2%/Simvastatin 2% Topical Gel

Add

Adding

Radio 3

CheckboxCiclopirox Olamine 8%/Terbinafine HCl 2% Topical Nail Liquid

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Adding

Radio 3

CheckboxChlorothiazide 40 mg/ml Gastric Tube Liquid

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Adding

Radio 3

CheckboxCholine Chloride 100 mg/Cyanocobalamin 1 mg/Inositol 50 mg/Methionine 15 mg Oral Capsules

Add

Adding

Radio 3

CheckboxCimetidine HCl 10%/Deoxy-D-Glucose 0.29%/Ibuprofen 2% Topical Gel

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Adding

Radio 3

CheckboxCholine Cl 110 mg/Cyanocobalamin 1 mg/Inositol 20 mg/Methionine 160 mg/Pyridoxine HCl 25 mg Oral Capsules

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Adding

Radio 3

CheckboxChloral Hydrate 500 mg Oral Capsules

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Adding

Radio 3

CheckboxChloramphenicol 6% Oral Liquid

Add

Adding

Radio 3

CheckboxChloral Hydrate 325 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxChloramphenicol 1%/Hydrocortisone 0.5%/Niacinamide 3%/Sulfur 7.8% Topical Cream

Add

Adding

Radio 3

CheckboxCimetidine 400 mg Oral Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxCholine Chloride 25 mg/ml/Calcium Pantothenate 25 mg/ml Oral Liquid

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Adding

Radio 3

CheckboxCiclopirox Olamine 7.77% Topical Nail lacquer Liquid

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Adding

Radio 3

CheckboxChrysin 5%/Testosterone 10% Topical Cream

Add

Adding

Radio 3

CheckboxChrysin 50 mg/Progesterone 5 mg/Testosterone 200 mg/2 mL Topical Cream

Add

Adding

Radio 3

CheckboxCiclopirox Olamine 1.5%/Salicylic Acid 3% Topical Shampoo

Add

Adding

Radio 3

CheckboxCephalexin 250 mg/5 mL Oral Liquid (Dye Free)

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 1% Topical Lotion

Add

Adding

Radio 3

CheckboxCholine Chloride 100 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxCimetidine 625 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxChloramphenicol 1% Otic Liquid

Add

Adding

Radio 3

CheckboxCiclopirox Olamine 1.5% Topical Liquid

Add

Adding

Radio 3

CheckboxChondroitin 500 mg/Glucosamine 532 mg/Methimazole 10 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxChlorpromazine HCl 50 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxChromium 24.876 Âµg/Phentermine HCl 45 mg Oral Capsules

Add

Adding

Radio 3

CheckboxCimetidine 150 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxChloral Hydrate 50 mg/Hydroxyzine Pamoate 2.5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 1%/Clindamycin 2%/Pyruvic Acid 1% Topical Cream

Add

Adding

Radio 3

CheckboxChlorpromazine HCl 11.1 mg/0.1 mL Transdermal Gel (Vet)

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 2% Topical Wash

Add

Adding

Radio 3

CheckboxChlorpromazine HCl 27.75 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxCelecoxib 200 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxCiclopirox Olamine 1.5% Topical Shampoo

Add

Adding

Radio 3

CheckboxCimetidine 300 mg/5 mL Oral Liquid

Add

Adding

Radio 3

CheckboxCelecoxib 25 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxCholesterol 250 mg Oral Capsules

Add

Adding

Radio 3

CheckboxCholestyramine 6.5% Topical Ointment

Add

Adding

Radio 3

CheckboxCiclopirox Olamine 6% Topical Gel

Add

Adding

Radio 3

CheckboxCholestyramine 10%/Nystatin 10%/Zinc Oxide 10% Topical Ointment

Add

Adding

Radio 3

CheckboxCholine Chloride 50 mg/Cyanocobalamin 0.5 mg/Inositol 50 mg/Methionine 25 mg/0.5 mL Sublingual Drops

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 0.12%/Lidocaine HCl 2%/Triamcinolone Acetonide 0.1% Oral Rinse

Add

Adding

Radio 3

CheckboxCiclopirox Olamine 8%/Ibuprofen 2%/Terbinafine HCl 1%/Urea 20% Topical Nail Lacquer

Add

Adding

Radio 3

CheckboxCholesterol 2%/Lovastatin 2% Topical Gel

Add

Adding

Radio 3

CheckboxCiclopirox Olamine 8% Nail Lacquer

Add

Adding

Radio 3

CheckboxChlorpheniramine Maleate 2 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 2%/Clindamycin Phosphate 1.2% Topical Wash

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 2% Oral Rinse

Add

Adding

Radio 3

CheckboxChrysin 50 mg/Dehydroepiandrosterone 15 mg/Prosgesterone 10 mg/Testosterone 150 mg Oral Troche

Add

Adding

Radio 3

CheckboxChloral Hydrate 100 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxChlorhexidine Gluconate 0.2% Nasal Spray

Add

Adding

Radio 3

CheckboxChloramphenicol 1% Topical Paste

Add

Adding

Radio 3

CheckboxChromium Picolinate 0.4 mg/ml/Zinc Sulfate 13.7 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxChloramphenicol 150 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxChrysin 200 mg Oral Capsules

Add

Adding

Radio 3

CheckboxCiprofloxacin 0.3% Otic Liquid

Add

Adding

Radio 3

CheckboxCamphor 5%/Indomethacin 5%/Menthol 5% Topical Gel

Add

Adding

Radio 3

CheckboxCamphor 2%/Cyclobenzaprine HCl 5%/Ketoprofen 10%/Lidocaine 2%/Menthol 2%/Tramadol HCl 5% Topical Cream

Add

Adding

Radio 3

CheckboxCalcium Citrate 1000 mg/10 mL Oral Liquid

Add

Adding

Radio 3

CheckboxCarbamazepine 3%/Gabapentin 6%/Imipramine HCl 3%/Meloxicam 0.5%/Pentoxifylline 3% Topical Gel

Add

Adding

Radio 3

CheckboxCaffeine 75 mg/Indomethacin 25 mg/Prochlorperazine 4 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxCaffeine 60 mg/Ketoprofen 25 mg/Magnesium Glycinate 100 mg/Riboflavin 100 mg Oral Capsules

Add

Adding

Radio 3

CheckboxCaffeine 100 mg/Ergotamine Tartrate 2 mg Rectal Suppository

Add

Adding

Radio 3

CheckboxCaffeine 60 mg/Ketoprofen 25 mg/Magnesium Citrate 100 mg/Riboflavin 100 mg Oral Capsules

Add

Adding

Radio 3

CheckboxCarbidopa 50 mg/Levodopa 200 mg Slow Release (MEM4) Oral Capsules

Add

Adding

Radio 3

CheckboxCarnitine-L 215 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxCamphor 1%/Sulfur 7% Topical Lotion

Add

Adding

Radio 3

CheckboxCalcium Gluconate 650 mg Oral Capsules

Add

Adding

Radio 3

CheckboxCamphor 2%/Diclofenac Sodium 4%/Menthol 1% Transdermal Gel

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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