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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.

First

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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

CheckboxSpironolactone 25 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxStearic Acid 2.5% Topical Cream

Add

Adding

Radio 3

CheckboxSpironolactone 5% Topical Gel

Add

Adding

Radio 3

CheckboxSpironolactone 5 mg/ml Oral Suspension (Gluten Free)

Add

Adding

Radio 3

CheckboxSpironolactone 5%/Niacinamide 2%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxSquaric Acid Dibutyl Ester 1% Topical Solution

Add

Adding

Radio 3

CheckboxSpironolactone 1%/Finasteride 0.5%/Estradiol 0.06%/Melatonin 0.05% Topical Solution

Add

Adding

Radio 3

CheckboxSpironolactone 50 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxSpironolactone 5 mg/ml/Hydrochlorothiazide 5 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxSpironolactone 1% Topical Solution

Add

Adding

Radio 3

CheckboxSodium Phosphate Monobasic 1936 mg/5 ml Oral Solution

Add

Adding

Radio 3

CheckboxSpironolactone 1 mg/ml Oral Syrup

Add

Adding

Radio 3

CheckboxSodium Thiosulfate Pentahydrate 25% Topical Cream

Add

Adding

Radio 3

CheckboxSodium Phosphate 5% Topical Cream

Add

Adding

Radio 3

CheckboxSodium Thiosulfate 25% Shampoo

Add

Adding

Radio 3

CheckboxSodium Phosphate 2% Topical Cream

Add

Adding

Radio 3

CheckboxSodium Thiosulfate 25%/Zinc Oxide 20% Topical Gel

Add

Adding

Radio 3

CheckboxSodium Hyaluronate 0.5% Topical Gel

Add

Adding

Radio 3

CheckboxSodium Lauryl Sulfate 30% Topical Solution

Add

Adding

Radio 3

CheckboxSodium Valproate 8.3% Topical Solution

Add

Adding

Radio 3

CheckboxSodium Thiosulfate 25% Topical Lotion

Add

Adding

Radio 3

CheckboxSodium Chloride 8.8 mg/Calcium Chloride 3.4 mg/Potassium Chloride 3.1 mg Troche

Add

Adding

Radio 3

CheckboxSodium Phosphate Dibasic Heptahydrate 0.9 Gm/5 ml/Sodium Phosphate Monobasic Monohydrate 2.4 Gm/5 ml Oral Solution

Add

Adding

Radio 3

CheckboxSorbitol 300 mg Troche

Add

Adding

Radio 3

CheckboxSodium Butyrate 100 Mm Enema

Add

Adding

Radio 3

CheckboxSimvastatin 2%/Cholesterol 2% Topical Gel

Add

Adding

Radio 3

CheckboxSodium Chloride 4 meq/ml Oral Solution

Add

Adding

Radio 3

CheckboxSodium Chloride 1 meq/ml Oral Solution

Add

Adding

Radio 3

CheckboxSodium Borate 1.5% Topical Solution

Add

Adding

Radio 3

CheckboxSodium Acetate 60 Mm/Sodium Propionate 30 Mm/Sodium Butyrate 40 Mm Enema

Add

Adding

Radio 3

CheckboxSodium Bicarbonate 2% Topical Gel

Add

Adding

Radio 3

CheckboxSkin Peel Neutralizer

Add

Adding

Radio 3

CheckboxSodium Bicarbonate 5% Mouth Rinse

Add

Adding

Radio 3

CheckboxSodium Bicarbonate 333 mg/Citric Acid 271 mg Suppository

Add

Adding

Radio 3

CheckboxSildenafil 25 mg Vaginal Suppository

Add

Adding

Radio 3

CheckboxSodium Alginate 10 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxSildenafil 20 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxSodium Benzoate 1.5% Oral Rinse

Add

Adding

Radio 3

CheckboxSodium Butyrate 264 mg Suppository

Add

Adding

Radio 3

CheckboxSildenafil 20 mg Troche

Add

Adding

Radio 3

CheckboxSildenafil 2%/Arginine HCl Vaginal Gel

Add

Adding

Radio 3

CheckboxSildenafil 1% Topical Cream

Add

Adding

Radio 3

CheckboxSildenafil 5% Topical Gel

Add

Adding

Radio 3

CheckboxSildenafil 1 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxSildenafil 10 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxSildenafil 1%/Testosterone 0.1% VaginalÂ Gel

Add

Adding

Radio 3

CheckboxSildenafil 2.5 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxSildenafil 1%/Testosterone 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxSertraline 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxScopolamine HBr 1 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxSertraline 20 mg/ml Oral Concentrate Solution (Gluten Free)

Add

Adding

Radio 3

CheckboxSelegiline HCl 5 mg/0.5 ml Topical Gel

Add

Adding

Radio 3

CheckboxSelenium Sulfide 2.5%/Zinc Pyrithione 1%/Urea 2.25% Shampoo

Add

Adding

Radio 3

CheckboxSildenafil 0.2%/Arginine HCl 1% Vaginal Gel

Add

Adding

Radio 3

CheckboxSelegiline HCl 1 mg/0.05 ml Oral Suspension

Add

Adding

Radio 3

CheckboxSertraline 4 mg/0.1 ml Topical Gel

Add

Adding

Radio 3

CheckboxScopolamine HBr 0.5 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxScopolamine HBr 1.2 mg Capsules

Add

Adding

Radio 3

CheckboxSalicylic Acid 80% Topical Paste

Add

Adding

Radio 3

CheckboxScopolamine HBr 0.1 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxSalicylic Acid 40% Topical Ointment

Add

Adding

Radio 3

CheckboxSalicylic Acid 30% Topical Peel

Add

Adding

Radio 3

CheckboxSalicylic Acid 40% Topical Peel Gel

Add

Adding

Radio 3

CheckboxScopolamine 0.25 mg/0.1 ml Topical Gel

Add

Adding

Radio 3

CheckboxSalicylic Acid 30% Topical Gel

Add

Adding

Radio 3

CheckboxSalicylic Acid 26% Topical Gel

Add

Adding

Radio 3

CheckboxSalicylic Acid 20%/Menthol 0.1% Topical Cream

Add

Adding

Radio 3

CheckboxSalicylic Acid 16.7%/Trichloroacetic Acid 12%/Flexible Collodion Topical Solution

Add

Adding

Radio 3

CheckboxSalicylic Acid 16.67% Compound Collodion Topical Solution

Add

Adding

Radio 3

CheckboxSalicylic Acid 17% Topical Solution

Add

Adding

Radio 3

CheckboxSalicylic Acid 26% Topical Solution

Add

Adding

Radio 3

CheckboxSalicylic Acid 27% Topical Gel

Add

Adding

Radio 3

CheckboxSalicylic Acid 26%/Flexible Collodion Topical Solution

Add

Adding

Radio 3

CheckboxSalicylic Acid 25% In Flexible Collodion

Add

Adding

Radio 3

CheckboxSalicylic Acid 14% Topical Chemical Peel

Add

Adding

Radio 3

CheckboxSalicylic Acid 10%/Cimetidine 10% Topical Lipoderm®

Add

Adding

Radio 3

CheckboxSalicylic Acid 14%/Trichloroacetic Acid 10%/Citric Acid 5%/Kojic Acid 3%/Hydroquinone 2% Peel Solution

Add

Adding

Radio 3

CheckboxSalicylic Acid 6%/Coal Tar Topical Solution 5%/Clobetasol Propionate 0.05% Topical Gel

Add

Adding

Radio 3

CheckboxSalicylic Acid 15%/Cimetidine 10%/Acyclovir 5%/Lidocaine 5%/Ibuprofen 2% Topical Occlusaderm®

Add

Adding

Radio 3

CheckboxSalicylic Acid 13.6%/Benzoic Acid 18.2% Topical Ointment

Add

Adding

Radio 3

CheckboxSalicylic Acid 10% Topical Solution

Add

Adding

Radio 3

CheckboxSalicylic Acid 10%/Coal Tar Topical Solution 5% Topical Oil

Add

Adding

Radio 3

CheckboxSalicylic Acid 15%/Cimetidine 5% Topical Occlusaderm®

Add

Adding

Radio 3

CheckboxSalicylic Acid 12% Topical Gel

Add

Adding

Radio 3

CheckboxSalicylic Acid 3%/Fluconazole 2%/Ibuprofen 2%/Terbinafine HCl 1% Topical Nail Gel

Add

Adding

Radio 3

CheckboxSalicylic Acid 2%/Niacinamide 5% Topical Cream

Add

Adding

Radio 3

CheckboxSalicylic Acid 2%/Clobetasol Propionate 0.05%/Triamcinolone 0.025% Topical Solution

Add

Adding

Radio 3

CheckboxSalicylic Acid 3%/Benzoic Acid 5% Topical Ointment

Add

Adding

Radio 3

CheckboxSalicylic Acid 6% Topical Gel

Add

Adding

Radio 3

CheckboxSalicylic Acid 6%/Coal Tar Topical Solution 5%/Clobetasol Propionate 0.05% Topical Cream

Add

Adding

Radio 3

CheckboxSalicylic Acid 2% Topical Cream

Add

Adding

Radio 3

CheckboxSalicylic Acid 0.5% Topical Ointment

Add

Adding

Radio 3

CheckboxSalicylic Acid 1.8% Scalp Lotion

Add

Adding

Radio 3

CheckboxSalicylic Acid 0.3% Mouthwash

Add

Adding

Radio 3

CheckboxSalicylic Acid 0.3%/Hydrogen Peroxide 1.5% Oral Rinse

Add

Adding

Radio 3

CheckboxSalicylic Acid 2% Shampoo

Add

Adding

Radio 3

CheckboxSalicylic Acid 1.76%/Anthralin 0.09%/Zinc Oxide 20% Topical Paste

Add

Adding

Radio 3

CheckboxSalicylic Acid 1.5%/Aloe Vera 0.5% Topical Solution

Add

Adding

Radio 3

CheckboxRutin 5% Topical Gel

Add

Adding

Radio 3

CheckboxRonidazole 150 mg Capsules (Vet)

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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