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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

CheckboxTris 0.6%/Edetate Disodium 0.02% Buffered Otic Solution (Vet)

Add

Adding

Radio 3

CheckboxUrea 10%/Ammonium Lactate 2.5% Topical Cream

Add

Adding

Radio 3

CheckboxTromethamine 0.15%/Edetate Disodium 0.12% Poloxamer Otic Gel (Vet)

Add

Adding

Radio 3

CheckboxTrolamine Oleate Otic Solution

Add

Adding

Radio 3

CheckboxUrea 10%/Sodium Hyaluronate 0.5% Topical Gel

Add

Adding

Radio 3

CheckboxTropicamide 1 mg Troche

Add

Adding

Radio 3

CheckboxTrolamine Salicylate 20%/Ketoprofen 10% Topical Lotion

Add

Adding

Radio 3

CheckboxUrea 8%/Mupirocin 0.8%/Clobetasol Propionate 0.005%/Nystatin 30,000 U/Gm Topical Ointment

Add

Adding

Radio 3

CheckboxTrimeprazine 5 mg/Prednisolone 2 mg Slow Release Capsules (Vet)

Add

Adding

Radio 3

CheckboxTrimethoprim 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxTrimeprazine 2.5 mg Capsules

Add

Adding

Radio 3

CheckboxTrimeprazine 5 mg/Prednisolone 2 mg Capsules (Vet)

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Adding

Radio 3

CheckboxTrichloroacetic Acid 35% Topical Solution

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Adding

Radio 3

CheckboxTrichloroacetic Acid 10% Topical Solution

Add

Adding

Radio 3

CheckboxTrichloroacetic Acid 7%/Salicylic Acid 2%/Mandelic Acid 2% Topical Solution

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Adding

Radio 3

CheckboxTrichloroacetic Acid 15%/Phenol Liquefied 0.5% Topical Solution

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Adding

Radio 3

CheckboxTrichloroacetic Acid 10%/Salicylic Acid 0.5%/Phenol Liquefied 0.1% Topical Solution

Add

Adding

Radio 3

CheckboxTrichloroacetic Acid 90% Topical Gel

Add

Adding

Radio 3

CheckboxTrilostane 50 mg/ml Oral Suspension (Vet)

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Adding

Radio 3

CheckboxTrimeprazine 5 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxTrichloroacetic 20% /Salicylic Acid 60% Topical Paste

Add

Adding

Radio 3

CheckboxTriamcinolone Acetonide 55 Mcg/0.1 ml Nasal Spray

Add

Adding

Radio 3

CheckboxTrichloroacetic Acid 20% Topical Solution

Add

Adding

Radio 3

CheckboxTriamcinolone 0.1% Topical Solution

Add

Adding

Radio 3

CheckboxTriamcinolone Acetonide 0.1%/Aloe Vera 0.5% Vaginal Gel

Add

Adding

Radio 3

CheckboxTriamcinolone Acetonide 0.04% Topical Spray

Add

Adding

Radio 3

CheckboxTriamcinolone Acetonide 0.015% Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxTriamcinolone Acetonide 0.1% Topical Shampoo

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Adding

Radio 3

CheckboxTriamcinolone Acetonide 0.05% Oil Otic Solution

Add

Adding

Radio 3

CheckboxTriamcinolone Acetonide 0.1% Oral Rinse

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Adding

Radio 3

CheckboxTriamcinolone Acetonide 0.1%/Minoxidil 5% Topical Foam

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Adding

Radio 3

CheckboxTriamcinolone 4 mg Capsules

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Adding

Radio 3

CheckboxTriamcinolone Acetonide 0.1%/Aloe Vera 0.5% Topical Gel

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Adding

Radio 3

CheckboxTretinoin 0.025%/Hydrocortisone 1%/Hydroquinone 10% Topical Cream

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Adding

Radio 3

CheckboxTretinoin 0.025% Topical Ointment

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Adding

Radio 3

CheckboxTretinoin 5% Topical Peel

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Adding

Radio 3

CheckboxTretinoin 10 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxTretinoin 0.05%/Triamcinolone 0.05%/Hydroquinone 7% Topical Cream

Add

Adding

Radio 3

CheckboxTretinoin 0.025%/Hydroquinone 4%/Betamethasone Valerate 0.1% Hand Cream

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Adding

Radio 3

CheckboxTriamcinolone 0.1% Oral Adhesive Paste

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Adding

Radio 3

CheckboxTri-Est 0.625 mg/ml Topical Cream

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Adding

Radio 3

CheckboxTri-Est 1.25 mg/ml Topical Cream

Add

Adding

Radio 3

CheckboxTretinoin 0.05%/Triamcinolone 0.05%/Hydroquinone 10% Topical Cream

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Adding

Radio 3

CheckboxTri-Est 2.5 mg/ml Topical Cream

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Adding

Radio 3

CheckboxTretinoin 5% Topical Peel Cream

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Adding

Radio 3

CheckboxTretinoin 1 mg/Clobetasol Propionate 0.5 mg Troche

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Adding

Radio 3

CheckboxTriamcinolone 0.1% Oral Rinse

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Adding

Radio 3

CheckboxTretinoin 0.025%/Hydrocortisone 1%/Hydroquinone 5% Topical Cream

Add

Adding

Radio 3

CheckboxTretinoin 0.025%/Hydrocortisone 1%/Hydroquinone 7% Topical Cream

Add

Adding

Radio 3

CheckboxTretinoin 0.05%/Triamcinolone 0.05%/Hydroquinone 5% Topical Cream

Add

Adding

Radio 3

CheckboxTretinoin 0.1%/Hydroquinone 5%/Dexamethasone 0.1% Topical Ointment

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Adding

Radio 3

CheckboxTretinoin 0.3% Topical Solution

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Adding

Radio 3

CheckboxTretinoin 0.05% Topical Ointment

Add

Adding

Radio 3

CheckboxTretinoin 0.02%/Ascorbic Acid 2%/Palmitoyl Pentapeptide-4/Aloe Vera Topical Serum

Add

Adding

Radio 3

CheckboxTretinoin 0.1%/Clobetasol Propionate 0.05% Oral Rinse

Add

Adding

Radio 3

CheckboxTretinoin 0.1%/Triamcinolone 0.1%/Hydroquinone 5% Topical Gel

Add

Adding

Radio 3

CheckboxTretinoin 0.2% Topical Cream

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Adding

Radio 3

CheckboxTrazodone HCl 300 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxTrazodone HCl 100 mg/ml Oral Suspension (Vet)

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Adding

Radio 3

CheckboxTrazodone HCl 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxTretinoin 0.1%/Clobetasol Propionate 0.05% Oral Adhesive Paste

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Adding

Radio 3

CheckboxTrazodone HCl 100 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxTrazodone HCl 50 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxTrazodone HCl 150 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxTrazodone HCl 100 mg/Gm Topical Cream (Vet)

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Adding

Radio 3

CheckboxTretinoin 0.1% Topical Ointment

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Adding

Radio 3

CheckboxTranexamic Acid 400 mg Capsules

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Adding

Radio 3

CheckboxTranexamic Acid 7% Topical Cream

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Adding

Radio 3

CheckboxTranexamic Acid 250 mg Capsules

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Adding

Radio 3

CheckboxTranexamic Acid 10% Nasal Spray

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Adding

Radio 3

CheckboxTranexamic Acid 10% Nasal Spray

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Adding

Radio 3

CheckboxTranexamic Acid 5% Ophthalmic Solution

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Adding

Radio 3

CheckboxTranexamic Acid 4.8% Solution

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Adding

Radio 3

CheckboxTranexamic Acid 10% Nasal Drop

Add

Adding

Radio 3

CheckboxTranexamic Acid 4.8% Oral Rinse

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Adding

Radio 3

CheckboxTramadol HCl 100 mg/Gm Topical Cream

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Adding

Radio 3

CheckboxTranexamic Acid 3% Topical Solution

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Adding

Radio 3

CheckboxTramadol HCl 50 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxTramadol HCl 50 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxTranexamic Acid 4.8% Oral Gel

Add

Adding

Radio 3

CheckboxTramadol HCl 20 mg/0.25 ml Topical Cream

Add

Adding

Radio 3

CheckboxTranexamic Acid 3%/Kojic Acid 1%/Niacinamide 5% Topical Gel

Add

Adding

Radio 3

CheckboxTranexamic Acid 3%/Kojic Acid 2% Topical Cream

Add

Adding

Radio 3

CheckboxTramadol HCl 50 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxTramadol HCl 5 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxTobramycin 160 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxTobramycin 160 mg/Amphotericin B 10 mg/Fluticasone Propionate 3 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxTopiramate 5 mg/ml To 25 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxTramadol HCl 5%/Lidocaine 5%/Cyclobenzaprine HCl 2%/Diclofenac Sodium 5%/Menthol 1%/DMSO Topical Lipoderm ActivemaxÂ®

Add

Adding

Radio 3

CheckboxTobramycin 125 mg/Vancomycin 160 mg/Budesonide 0.6 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxTramadol HCl 10 mg/0.1 ml/Gabapentin 5 mg/0.1 ml Topical LipodermÂ® (Vet)

Add

Adding

Radio 3

CheckboxTobramycin 160 mg/Itraconazole 50 mg/Fluticasone Propionate 3 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxTragacanth 1.37% Oral Mucilage

Add

Adding

Radio 3

CheckboxTopiramate 2.5% Topical Gel

Add

Adding

Radio 3

CheckboxTramadol HCl 5%/Lidocaine 5%/Cyclobenzaprine HCl 2%/Diclofenac Sodium 2%/Menthol 1%/DMSO Topical Lipoderm ActivemaxÂ®

Add

Adding

Radio 3

CheckboxTopiramate 2.5%/Aloe Vera 0.5% Topical Gel

Add

Adding

Radio 3

CheckboxTobramycin 125 mg/Mometasone Furoate 0.6 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxTobramycin 125 mg/Budesonide 0.6 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxTobramycin 100 mg/Betamethasone 0.5 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxTobramycin 125 mg/Amphotericin B 5 mg/Mometasone Furoate 0.6 mg Capsules (For Nasal Irrigation/Nebulizer)

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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