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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

CheckboxQuinidine Sulfate 300 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxQuinine Sulfate 10% Topical Gel

Add

Adding

Radio 3

CheckboxQuinine Sulfate 260 mg Capsules

Add

Adding

Radio 3

CheckboxQuetiapine 40 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxRonidazole 90 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxQuinidine Sulfate 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxRiboflavin 200 mg/Caffeine 30 mg/Ketoprofen 12.5 mg Capsules

Add

Adding

Radio 3

CheckboxRifampin 25 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxQuinine Sulfate 300 mg Capsules

Add

Adding

Radio 3

CheckboxRonidazole 90 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxQuinidine Sulfate 50 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxRonidazole 50 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxPyridoxine HCl 500 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPyrimethamine 50 mg/Leucovorin 10 mg Capsules

Add

Adding

Radio 3

CheckboxPyridoxine HCl 50 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPyrogallic Acid 25%/Chlorobutanol 2% Topical Ointment

Add

Adding

Radio 3

CheckboxPyrogallic Acid 10% Topical Ointment

Add

Adding

Radio 3

CheckboxPyrimethamine 5 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPyrimethamine 25 mg/Leucovorin 5 mg Capsules

Add

Adding

Radio 3

CheckboxQuercetin Dihydrate 200 mg Capsules

Add

Adding

Radio 3

CheckboxQuercetin Dihydrate 0.5% Nasal Spray

Add

Adding

Radio 3

CheckboxPyrimethamine 2 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPyridoxine HCl 3%/Ketotifen 0.05% Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxPyridoxine HCl 5 mg Troche

Add

Adding

Radio 3

CheckboxPyridoxine HCl 50 mg/ml/Pyridoxal-5-Phosphate 25 mg/ml/Riboflavin 10 mg/ml Topical Gel

Add

Adding

Radio 3

CheckboxPyridoxine HCl 10 mg Troche

Add

Adding

Radio 3

CheckboxPyridoxine HCl 5%/Zinc Oxide 1% Topical Cream

Add

Adding

Radio 3

CheckboxPyridoxine HCl 5%/Zinc Pyrithione 2% Topical Cream

Add

Adding

Radio 3

CheckboxPyridoxine HCl 5 mg/Thiamine HCl 10 mg Troche

Add

Adding

Radio 3

CheckboxPyridoxal-5-Phosphate 50 mg Capsules

Add

Adding

Radio 3

CheckboxPyridoxal-5-Phosphate 25 mg/Zinc 10 mg/Methylcobalamin 2 mg/Vitamin D3 2500 Iu Capsules

Add

Adding

Radio 3

CheckboxPyrantel 100 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPyrantel 180 mg/ml Oral Gel (Vet)

Add

Adding

Radio 3

CheckboxPyridoxal-5-Phosphate 100 mg Capsules

Add

Adding

Radio 3

CheckboxPyridostigmine Bromide 12 mg/ml Oral Syrup (Gluten Free)

Add

Adding

Radio 3

CheckboxPyrantel 50 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPyridoxine HCl 1 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPyridostigmine Bromide 20% Nasal Spray

Add

Adding

Radio 3

CheckboxPyrantel 180 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxPyridoxal-5-Phosphate 70 mg/Methylcobalamin 10 mg Capsules

Add

Adding

Radio 3

CheckboxPseudoephedrine HCl 30 mg/Guaifenesin 200 mg/Dextromethorphan HBr 10 mg Capsules

Add

Adding

Radio 3

CheckboxPseudoephedrine HCl 60 mg/Hydrocodone Bitartrate 5 mg Capsules

Add

Adding

Radio 3

CheckboxPseudoephedrine HCl 15 mgÂ Suppository

Add

Adding

Radio 3

CheckboxPseudocatalase Topical Cream

Add

Adding

Radio 3

CheckboxPseudoephedrine HCl 120 mg/Chlorpheniramine Maleate 8 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPseudoephedrine HCl 90 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPseudoephedrine HCl 60 mgÂ Suppository

Add

Adding

Radio 3

CheckboxPropranolol HCl 160 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPseudoephedrine HCl 60 mg/Chlorpheniramine Maleate 4 mg CapsulesÂ (Gluten Free)

Add

Adding

Radio 3

CheckboxPropylthiouracil 50 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxPropylthiouracil 5 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPseudoephedrine HCl 30 mgÂ Suppository

Add

Adding

Radio 3

CheckboxPseudocatalase Hair Serum

Add

Adding

Radio 3

CheckboxPropranolol HCl 60 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPropranolol HCl 80 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPromethazine HCl 125 mg/Gm Topical Gel

Add

Adding

Radio 3

CheckboxPromethazine HCl 50 mg/ml Topical Gel

Add

Adding

Radio 3

CheckboxPropranolol HCl 1 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPropranolol HCl 120 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxPropranolol HCl 20 mg Troche

Add

Adding

Radio 3

CheckboxPropranolol HCl 1% Topical Gel

Add

Adding

Radio 3

CheckboxPropranolol HCl 7.5 mg/0.1 ml Nasal Spray

Add

Adding

Radio 3

CheckboxPropafenone HCl 1.5 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPromethazine HCl 125 mg/ml Nasal Spray

Add

Adding

Radio 3

CheckboxPropranolol HCl 4% Topical Gel

Add

Adding

Radio 3

CheckboxPromethazine HCl 5 mg Troche

Add

Adding

Radio 3

CheckboxPromethazine HCl 12.5 mg/Gm To 25 mg/Gm Topical Lipoderm®

Add

Adding

Radio 3

CheckboxPromethazine HCl 50 mg Troche

Add

Adding

Radio 3

CheckboxPromethazine HCl 25 mg/Gm Topical Gel

Add

Adding

Radio 3

CheckboxPromethazine HCl 25 mg Troche

Add

Adding

Radio 3

CheckboxPromethazine HCl 25 mg Capsules

Add

Adding

Radio 3

CheckboxPromethazine HCl 12.5 mg Troche

Add

Adding

Radio 3

CheckboxPromethazine HCl 50 mg Capsules

Add

Adding

Radio 3

CheckboxPromethazine HCl 12.5 mg/0.1 ml Topical Gel

Add

Adding

Radio 3

CheckboxProgesterone 200 mg/ml Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 200 mg Troche

Add

Adding

Radio 3

CheckboxProgesterone 600 mg Suppository

Add

Adding

Radio 3

CheckboxProgesterone 400 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxProgesterone 200 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxProgesterone 250 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxProgesterone 300 mg Troche

Add

Adding

Radio 3

CheckboxPromethazine HCl 3.13 mg/Aspirin 300 mg/Pseudoephedrine HCl 30 mg Capsules

Add

Adding

Radio 3

CheckboxProgesterone 200 mg/ml Enema Suspension

Add

Adding

Radio 3

CheckboxProgesterone 200 mg/Gm Topical Gel

Add

Adding

Radio 3

CheckboxProgesterone 400 mg Suppository

Add

Adding

Radio 3

CheckboxProgesterone 200 mg Rapid Dissolve Tablet

Add

Adding

Radio 3

CheckboxProgesterone 150 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxProgesterone 175 mg Troche

Add

Adding

Radio 3

CheckboxProgesterone 200 mg Troche

Add

Adding

Radio 3

CheckboxProgesterone 100 mg/ml Sublingual Suspension

Add

Adding

Radio 3

CheckboxProgesterone 100 mg/ml Topical Cream

Add

Adding

Radio 3

CheckboxProgesterone 200 mg Suppository

Add

Adding

Radio 3

CheckboxProgesterone 100 mg/Gm Vaginal Gel

Add

Adding

Radio 3

CheckboxProgesterone 200 mg Capsules (Gluten Free/Peanut Oil Free)

Add

Adding

Radio 3

CheckboxProgesterone 100 mg/ml Enema Suspension

Add

Adding

Radio 3

CheckboxProgesterone 175 mg/Gm Topical Gel

Add

Adding

Radio 3

CheckboxProgesterone 150 mg/Gm Topical Gel

Add

Adding

Radio 3

CheckboxProgesterone 100 mg Troche

Add

Adding

Radio 3

CheckboxProgesterone 75 mg Troche

Add

Adding

Radio 3

CheckboxProgesterone 75 mg Slow Release Capsules

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!

Oops! Something went wrong while submitting the form.