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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

CheckboxNaltrexone HCl 4 mg Capsules

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Adding

Radio 3

CheckboxNaltrexone HCl 4.5 mg Capsules

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Adding

Radio 3

CheckboxNaltrexone HCl 5 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxNaltrexone HCl 1%/Doxepin HCl 0.5% Topical Cream

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Adding

Radio 3

CheckboxNaltrexone HCl 1%/Ketotifen 0.05% Topical Cream

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Adding

Radio 3

CheckboxNaltrexone HCl 100 mg/ml Topical Cream

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Adding

Radio 3

CheckboxNaltrexone HCl 50 mg/ml Oral Suspension (Vet)

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Adding

Radio 3

CheckboxNaltrexone HCl 10 mg/ml Oral Solution

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Adding

Radio 3

CheckboxNaltrexone HCl 1%/Pramoxine HCl 1% Topical Gel

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Adding

Radio 3

CheckboxNaltrexone HCl 5 mg/60 ml Rectal Suspension Enema

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Adding

Radio 3

CheckboxNaltrexone HCl 5 mg Capsules

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Adding

Radio 3

CheckboxNaltrexone HCl 100 mg/ml Topical Gel

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Adding

Radio 3

CheckboxNaltrexone HCl 3 mg Capsules

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Adding

Radio 3

CheckboxNaltrexone HCl 0.25 mg Capsules

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5% Nasal Spray

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Adding

Radio 3

CheckboxNadolol 20 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxNadolol 10 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5%/Azelastine HCl 0.175%/Ketotifen 0.05% Topical Cream

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Adding

Radio 3

CheckboxNaltrexone HCl 1.5 mg Capsules

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5 mg/Sodium Butyrate Slow Release Ar Capsules

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Adding

Radio 3

CheckboxNadolol 20 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5%/Azelastine HCl 0.175% Nasal Spray

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Adding

Radio 3

CheckboxNaltrexone HCl 1% Topical Cream

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Adding

Radio 3

CheckboxNaltrexone HCl 1% Topical Gel

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5% Otic Solution

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5%/Ketotifen 0.05% Topical Gel

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Adding

Radio 3

CheckboxNadolol 80 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5%/Azelastine HCl 0.1% Topical Gel

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Adding

Radio 3

CheckboxNaltrexone HCl 1 Mcg Capsules

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5%/Ketotifen 0.05%/Tacrolimus 0.03% Topical/Vaginal

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5% Topical Gel

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Adding

Radio 3

CheckboxNadolol 10 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5%/Tacrolimus 0.1% Topical Gel

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Adding

Radio 3

CheckboxNaltrexone HCl 1% Scalp Solution

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5 mg Capsules

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5% Vaginal Gel

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Adding

Radio 3

CheckboxNaltrexone HCl 1 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxNaltrexone HCl 1%/Azelastine HCl 0.15% Topical Gel

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Adding

Radio 3

CheckboxNaltrexone HCl 0.1% Topical Cream

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Adding

Radio 3

CheckboxNadolol 160 mg Capsules

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Adding

Radio 3

CheckboxNadolol 40 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxNaltrexone HCl 0.5 mg/ml To 5 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxMupirocin 20 mg/Budesonide 0.6 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 20 mg/Fluconazole 15 mg/Betamethasone 0.75 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 5%/Vancomycin 5% Topical Gel

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Adding

Radio 3

CheckboxMupirocin 5 mg/Budesonide 0.6 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 20 mg/Clotrimazole 10 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 15 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 5% Topical Gel

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Adding

Radio 3

CheckboxMupirocin 15 mg/Budesonide 0.6 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 20 mg/Clotrimazole 10 mg/Betamethasone 0.75 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxMupirocin 200 mg/Vancomycin 50 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 5 mg/Mometasone Furoate 0.6 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 20 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 200 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 100 mg/Fluticasone Propionate 3 mg/Fluconazole 15 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxMupirocin 20 mg/Fluconazole 15 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxMupirocin 5%/Tobramycin 5%/Itraconazole 2% Topical Gel

Add

Adding

Radio 3

CheckboxMupirocin 100 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 100 mg/Amphotericin B 10 mg/Fluticasone Propionate 3 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 50 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 5 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 100 mg/Fluticasone Propionate 3 mg/Itraconazole 50 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxMycophenolate Mofetil 100 mg/ml Oral Suspension (Vet)

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Adding

Radio 3

CheckboxMupirocin 50 mg/Betamethasone 0.75 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxMupirocin 1.4%/Nystatin 30,000 U/Gm Topical Paste

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Adding

Radio 3

CheckboxMorphine Sulfate 210 mg Slow Release Capsules

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Adding

Radio 3

CheckboxMorphine Sulfate 100 mg Slow Release Capsules (Gluten Free)

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Radio 3

CheckboxMorphine Sulfate 130 mg Slow Release Capsules

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Radio 3

CheckboxMorphine Sulfate 120 mg Slow Release Capsules

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Adding

Radio 3

CheckboxMorphine Sulfate 150 mg Slow Release Capsules

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Adding

Radio 3

CheckboxMorphine Sulfate 75 mg Slow Release Capsules

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Adding

Radio 3

CheckboxMorphine Sulfate 240 mg Slow Release Capsules

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Adding

Radio 3

CheckboxMorphine Sulfate 65 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxMupirocin 0.2% Nasal Spray

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Adding

Radio 3

CheckboxMorphine Sulfate 400 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxMorphine Sulfate 200 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxMupirocin 2%/Lidocaine 1%/Nystatin 30,000 Units/Gm Topical Ointment

Add

Adding

Radio 3

CheckboxMorphine Sulfate 90 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxMoxifloxacin Hydrochloride 130 mg/Tobramycin 160 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxMupirocin 2% Topical Gel

Add

Adding

Radio 3

CheckboxMorphine Sulfate 270 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxMupirocin 0.2%/Fluconazole 0.75% Nasal Spray

Add

Adding

Radio 3

CheckboxMorphine Sulfate 180 mg Slow Release Capsules

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Adding

Radio 3

CheckboxMupirocin 1%/Betamethasone Acetate 0.025%/Clotrimazole 2% Topical Gel

Add

Adding

Radio 3

CheckboxMupirocin 2%/Lidocaine 1%/Ketoconazole 0.113% Lip Ointment

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Adding

Radio 3

CheckboxMorphine Sulfate 300 mg Slow Release Capsules

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Adding

Radio 3

CheckboxMoxifloxacin Hydrochloride 130 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxMorphine Sulfate 50 mg/ml Oral Solution

Add

Adding

Radio 3

CheckboxMorphine Sulfate 30 mgÂ Slow Release Suppository

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Adding

Radio 3

CheckboxMorphine Sulfate 10% Topical Gel

Add

Adding

Radio 3

CheckboxMorphine Sulfate 40 mg Slow Release Capsules

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Adding

Radio 3

CheckboxMorphine Sulfate 3% Topical Gel

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Adding

Radio 3

CheckboxMorphine Sulfate 15 mg Slow Release Capsules (Gluten Free)

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Adding

Radio 3

CheckboxMorphine Sulfate 60 mg Slow Release Capsules

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Adding

Radio 3

CheckboxMorphine Sulfate 40 mg/ml Oral Solution

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Adding

Radio 3

CheckboxMorphine Sulfate 0.4 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxMorphine Sulfate 50 mg/Metoclopramide 10 mg Suppository

Add

Adding

Radio 3

CheckboxMorphine Sulfate 1% Topical Gel

Add

Adding

Radio 3

CheckboxMorphine Sulfate 45 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!

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