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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

CheckboxMetoclopramide Hydrochloride 4 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxMethylcobalamin 3000 µg/mL Sublingual Solution

Add

Adding

Radio 3

CheckboxMethylcobalamin 20 mg Troches

Add

Adding

Radio 3

CheckboxMethscopolamine HBr 0.5 mg/mL/Potassium Citrate 100 mg/mL Oral Solution

Add

Adding

Radio 3

CheckboxMethscopolamine HBr 0.35 mg/mL/Neomycin Sulfate 4 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxMethotrexate 30 mg/g Topical Gel

Add

Adding

Radio 3

CheckboxMethocarbamol 375 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxMethocarbamol 50 mg/mL Oral Solution

Add

Adding

Radio 3

CheckboxMethimazole 5 mg/0.1 mL Topical Gel

Add

Adding

Radio 3

CheckboxMethenamine 5% Topical Lotion

Add

Adding

Radio 3

CheckboxMethadone Hydrochloride 30 mg/mL Oral Syrup

Add

Adding

Radio 3

CheckboxMetformin Hydrochloride 100 mg/mL Topical Cream

Add

Adding

Radio 3

CheckboxMetformin Hydrochloride 125 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxMercaptopurine 25 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxMercaptopurine 50 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxMetformin HCl 5%/Progesterone 1%/Spirolactone 5% Topical Gel

Add

Adding

Radio 3

CheckboxMercaptopurine 12 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxMenthol 7%/Methyl Salicylate 15% Topical Lotion

Add

Adding

Radio 3

CheckboxMelphalan Hydrochloride 0.5 mg Capsules

Add

Adding

Radio 3

CheckboxMeloxicam 15 mg/mL Topical Gel

Add

Adding

Radio 3

CheckboxMenthol 0.25%/Phenol 0.5%/Zinc Oxide 8% Topical Lotion

Add

Adding

Radio 3

CheckboxMelatonin 5 mg/g/Progesterone 5 mg/g Topical Cream

Add

Adding

Radio 3

CheckboxMeloxicam 0.5 mL/mL Oral Suspension

Add

Adding

Radio 3

CheckboxMelatonin 1 mg/mL/Pyridoxine HCl 0.1 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxMandelic Acid 5% Topical Cream

Add

Adding

Radio 3

CheckboxMalic Acid 1% Oral Solution

Add

Adding

Radio 3

CheckboxLosartan Potassium 25 mg/mL Topical Gel

Add

Adding

Radio 3

CheckboxLosartan Potassium 10 mg/mL Topical Gel

Add

Adding

Radio 3

CheckboxLorazepam 1 mg/mL Topical Gel

Add

Adding

Radio 3

CheckboxLoratadine 5 mg/0.5 mL Topical Gel

Add

Adding

Radio 3

CheckboxLoratadine 10 mg/g Topical Cream

Add

Adding

Radio 3

CheckboxLisinopril Dihydrate 10 mg/mL Topical Gel

Add

Adding

Radio 3

CheckboxLiothyronine Sodium 5 mcg/Hydrocortisone 5 mg Slow Release (ME4M) Oral Capsules

Add

Adding

Radio 3

CheckboxLiothyronine Sodium 5 mcg/0.1mL Topical Cream

Add

Adding

Radio 3

CheckboxLidocaine HCl 5 mg/mL Otic Solution

Add

Adding

Radio 3

CheckboxLidocaine HCl 40 mg/mL Iontophoresis Solution

Add

Adding

Radio 3

CheckboxLidocaine HCl 30 mg/Nifedipine 7 mg/Nitroglycerin 0.3 mg Suppositories

Add

Adding

Radio 3

CheckboxLidocaine HCl 20 mg/g/Misoprostol 0.024 mg/g/Phenytoin 20 mg/g Topical Powder

Add

Adding

Radio 3

CheckboxLidocaine HCl 2%/Metronidazole 2%/Misoprostol 0.0024%/Phenytoin 2% Topical Cream

Add

Adding

Radio 3

CheckboxLidocaine HCl 1%/Metronidazole 2%/Sucralfate 4% Topical Gel

Add

Adding

Radio 3

CheckboxLidocaine 100 mg/mL Topical Gel

Add

Adding

Radio 3

CheckboxLevofloxacin 50 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxLamotrigine 150 mg/5g Topical Cream

Add

Adding

Radio 3

CheckboxLamivudine 5 mg/mL Oral Solution

Add

Adding

Radio 3

CheckboxLactobacillus Acidophilus 300 mg Vaginal Suppositories

Add

Adding

Radio 3

CheckboxLactic Acid 5%/Podophyllum Resin 15%/Salicylic Acid 10% Topical Solution

Add

Adding

Radio 3

CheckboxLactic Acid 4%/Salicylic Acid 5%/Trichloroacetic Acid 2% Topical Solution

Add

Adding

Radio 3

CheckboxLactic Acid 17%/Resorcinol 8%/Salicylic Acid 17% Topical Solution

Add

Adding

Radio 3

CheckboxLactic Acid 14%/Resorcinol 14%/Salicylic Acid 14% Topical Solution

Add

Adding

Radio 3

CheckboxLactic Acid 12%/Pramoxine HCl 1% Topical Cream

Add

Adding

Radio 3

CheckboxLactic Acid 10%/Salicylic Acid 20%/Trichloroacetic Acid 20% Topical Solution

Add

Adding

Radio 3

CheckboxLactic Acid 10%/Salicylic Acid 15% Topical Solution

Add

Adding

Radio 3

CheckboxLactic Acid 10% Topical Cream

Add

Adding

Radio 3

CheckboxKetorolac Tromethamine 2% Topical Gel

Add

Adding

Radio 3

CheckboxKetoconazole 10 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxKetorolac Tromethamine 6 mg/mL Iontophoresis Solution

Add

Adding

Radio 3

CheckboxKetoconazole 1%/Salicylic Acid 10% Topical Solution

Add

Adding

Radio 3

CheckboxKetoconazole 1% Topical Solution

Add

Adding

Radio 3

CheckboxKetoconazole 10 mg/mL Nasal Spray

Add

Adding

Radio 3

CheckboxKetamine HCl 50 mg/mL/Ketoprofen 50 mg/mL Topical Gel

Add

Adding

Radio 3

CheckboxKetamine HCl 10 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxKetamine 40 mg/5mL Oral Solution

Add

Adding

Radio 3

CheckboxIvermectin 3 mg/mL Topical Gel

Add

Adding

Radio 3

CheckboxIvermectin 3 mg Capsules

Add

Adding

Radio 3

CheckboxIvermectin 2 mg/mL Oral Solution

Add

Adding

Radio 3

CheckboxIvermectin 10 mg/mL Topical Lotion

Add

Adding

Radio 3

CheckboxHydroxyzine Pamoate 10 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxHyoscyamine Sulfate 0.02mg/mL/Lidocaine 7 µg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxItraconazole 20 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxItraconazole 1% Topical Ointment

Add

Adding

Radio 3

CheckboxIsradipine 1 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxItraconazole 0.1% Topical Solution

Add

Adding

Radio 3

CheckboxHydroxyzine Dihydrochloride 25 mg Suppositories

Add

Adding

Radio 3

CheckboxIsoniazid 5 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxIsoniazid 100 mg Suppositories

Add

Adding

Radio 3

CheckboxHydroquinone 6% Topical Cream

Add

Adding

Radio 3

CheckboxIndomethacin 2 mg/mL Oral Syrup

Add

Adding

Radio 3

CheckboxIndomethacin 10 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxImiquimod 3.75% Topical Ointment

Add

Adding

Radio 3

CheckboxImatinib 40 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxIbuprofen 20%/Piroxicam 2% Topical Cream

Add

Adding

Radio 3

CheckboxHyoscyamine Sulfate 0.125 mg/mL/Phenobarbital 15 mg/mL Oral Drops

Add

Adding

Radio 3

CheckboxHydroxytryptophan 2 mg/5mL Oral Solution

Add

Adding

Radio 3

CheckboxHydroquinone 5%/Retinoic Acid 0.1%/Triamcinolone 0.1% Topical Ointment

Add

Adding

Radio 3

CheckboxHydroquinone 5%/Retinoic Acid 0.1%/Triamcinolone 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 5%/Retinoic Acid 0.1%/Triamcinolone 0.1% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 5% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 5% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 4%/Tretinoin 0.025% Topical Cream

Add

Adding

Radio 3

CheckboxHydromorphone HCl 1 mg Troches

Add

Adding

Radio 3

CheckboxHydroquinone 4%/Retinoic Acid 0.1%/Triamcinolone 0.1%/Vitamin E 1.75% Topical Cream

Add

Adding

Radio 3

CheckboxHydromorphone HCl 10 mg/mL Oral Drops

Add

Adding

Radio 3

CheckboxHydromorphone HCl 1 mg/mL Oral Suspension

Add

Adding

Radio 3

CheckboxHydrogen Peroxide 1.5%/Sodium Fluoride 0.5 mg/mL Oral Rinse

Add

Adding

Radio 3

CheckboxHydrocortisone Acetate 1%/Nitrofurazone 0.2% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone Acetate 1%/Miconazole 2%/Triple Antibiotic Topical Ointment

Add

Adding

Radio 3

CheckboxHydrocortisone 61.7 mg/Lidocaine 131.7 mg Rectal Rockets

Add

Adding

Radio 3

CheckboxHydrocortisone 25 mg Capsules

Add

Adding

Radio 3

CheckboxHydrocortisone 2%/Lidocaine 1%/Sucralfate 2% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 2% Oral Suspension

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.

Thank you! Your submission has been received!

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