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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

CheckboxHydroxyzine HCl 10 mg/Gm Topical Gel

Add

Adding

Radio 3

CheckboxHydroxyzine HCl 10 mg/0.1 ml Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxHydroquinone 20% Topical Ointment

Add

Adding

Radio 3

CheckboxHydroxyurea 500 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxHydroquinone 12%/Kojic Acid 6% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 20%/Hydrocortisone 1%/Glycolic Acid 10% Topical Lotion

Add

Adding

Radio 3

CheckboxHydroxocobalamin 400 Mcg Capsules

Add

Adding

Radio 3

CheckboxHydroquinone 20% Topical Gel

Add

Adding

Radio 3

CheckboxHydroxocobalamin 20 mg/ml Injection Solution

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Adding

Radio 3

CheckboxHydroquinone 12%/Kojic Acid 4%/Ascorbic Acid 4% Topical Gel

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Adding

Radio 3

CheckboxHydroxyzine HCl 50 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxHydroxyzine HCl 25 mg/5 ml Oral Suspension

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Adding

Radio 3

CheckboxHydroxyzine HCl 25 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxHydroxyzine HCl 10 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxHydroxychloroquine Sulfate 25 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxHydroxocobalamin 1 mg/ml Injection Solution

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Adding

Radio 3

CheckboxHydroxyurea 100 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxHyoscyamine Sulfate 0.125 mg/ml Drops (Flavored)

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Adding

Radio 3

CheckboxHyoscyamine Sulfate 0.375 mg Slow Release Capsules

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Adding

Radio 3

CheckboxHydroquinone 8%/Tretinoin 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 4%/Hydrocortisone 2.5%/Tretinoin 0.05%/Urea 10% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 4%/Tretinoin 0.05%/Ascorbic Acid 1% Topical Lotion

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Hydrocortisone 0.5%/Kojic Acid 6%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 5%/Ascorbic Acid 1%/Fluticasone Propionate 1%/Glycolic Acid 2.5% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 5%/Glycolic Acid 4% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Desonide 0.05%/Salicylic Acid 2%/Ascorbic Acid 5% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Kojic Acid 4%/Ascorbic Acid 5% Topical Lotion

Add

Adding

Radio 3

CheckboxHydroquinone 8% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 5%/Fluticasone Propionate 0.05%/Tretinoin 0.3% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Tretinoin 0.04%/Triamcinolone Acetonide 0.025% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 6% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Hydrocortisone 0.5%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 5%/Ascorbic Acid 10% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 7%/Kojic Acid 0.05%/Tretinoin 0.05%/Hydrocortisone 0.05% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 4%/Clindamycin 2% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 8%/Kojic Acid 6%/Tranexamic Acid 3% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Tretinoin 0.12%/Triamcinolone 0.12% Topical Ointment

Add

Adding

Radio 3

CheckboxHydroquinone 8%/Hydrocortisone 1%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 6%/Kojic Acid 6%/Hydrocortisone 0.5%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 4%/Tretinoin 0.05%/Fluocinolone Acetonide 0.01% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 4%/Niacinamide 4%/Tretinoin 0.05%/Fluocinolone Acetonide 0.01% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 6.25%/Tretinoin 0.025%/Fluocinolone Acetonide 0.01%/Tranexamic Acid 2%/Kojic Acid 4% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 10%/Ascorbic Acid 20%/Kojic Acid 5% Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 7%/Kojic Acid 0.05%/Hydrocortisone 0.05%/Tretinoin 0.05% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone Acetate 1%/Hydroquinone 4% Topical Cream

Add

Adding

Radio 3

CheckboxHydrogen Peroxide 10% Topical Gel

Add

Adding

Radio 3

CheckboxHydromorphone HCl 10 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxHydrocortisone Acetate 2.5%/Neomycin 3.5 mg/Gm Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone Acetate 0.2% Topical Cream

Add

Adding

Radio 3

CheckboxHydromorphone HCl 2 mg/ml Oral Solution

Add

Adding

Radio 3

CheckboxHydroquinone 4%/Ascorbic Acid 4% Topical Solution

Add

Adding

Radio 3

CheckboxHydromorphone HCl 8 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxHydrocortisone Acetate 0.5%/Neomycin 3.5 mg/Gm Topical Cream

Add

Adding

Radio 3

CheckboxHydroquinone 4% Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 2%/Hydrocortisone 1%/Glycolic Acid Topical Lotion

Add

Adding

Radio 3

CheckboxHydromorphone HCl 4 mg Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 100 mg Suppository

Add

Adding

Radio 3

CheckboxHydromorphone HCl 20 mg/ml Oral Solution

Add

Adding

Radio 3

CheckboxHydrocortisone Acetate 0.5%/Sodium Thiosulfate 8% Compound Topical Lotion

Add

Adding

Radio 3

CheckboxHydromorphone HCl 4 mg Troche

Add

Adding

Radio 3

CheckboxHydrocortisone Acetate 1%/Neomycin 3.5 mg/Gm Topical Cream

Add

Adding

Radio 3

CheckboxHydrogen Peroxide 15 mg/ml Oral Rinse

Add

Adding

Radio 3

CheckboxHydroquinone 2.5%/Salicylic Acid 1%/Kojic Acid 1%/Aloe Vera Topical Gel

Add

Adding

Radio 3

CheckboxHydroquinone 2%/Kojic Acid 8% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 30 mg Suppository

Add

Adding

Radio 3

CheckboxHydroquinone 4%/Ascorbic Acid 10%/Kojic Acid 4% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone Acetate 10%/Lidocaine 2%/Beta Glucan Rectal Gel

Add

Adding

Radio 3

CheckboxHydroquinone 3%/Clindamycin 2% Topical Solution

Add

Adding

Radio 3

CheckboxHydromorphone HCl 10 mg/ml Oral Solution

Add

Adding

Radio 3

CheckboxHydroquinone 3% Topical Solution

Add

Adding

Radio 3

CheckboxHydrocortisone Acetate 2%/Iodoquinol 1%/Aloe Vera 0.5%/Tea Tree Oil 1% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 10% Ultrasound Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 2%/Miconazole Nitrate 2%/Tetracaine HCl 0.5%/Neomycin 0.35% Topical Powder (Vet)

Add

Adding

Radio 3

CheckboxHydrocortisone 10%/Clindamycin 2%/Metronidazole 0.75% Vaginal Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 3.75 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxHydrocortisone 3.75 mg Capsules

Add

Adding

Radio 3

CheckboxHydrocortisone 10% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 3% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 2.5%/Pramoxine HCl 1% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 5 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxHydrocortisone 2.5%/Lidocaine 2% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 20% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 10% Vaginal Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 10 mg/Zinc Oxide 160 mg/Menthol 15 mg Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 10 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxHydrocortisone 2.5% Topical Solution

Add

Adding

Radio 3

CheckboxHydrocortisone 3%/Lidocaine 5%/Phenylephrine HCl 0.25%/Aloe Vera 0.5% Topical/Rectal Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 2% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 10 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxHydrocortisone 5 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxHydrocortisone 10 mg/Lidocaine 40 mg/Zinc Oxide 160 mg/Menthol 15 mg Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 10% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 10%/Estradiol 0.01% Vaginal Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 5% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 2.5%/Ibuprofen 2%/Miconazole 2% Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 10% Vaginal/Rectal Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 16.5 mg Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Neomycin 0.5% Topical Cream

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Lidocaine HCl 2% Rectal Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Miconazole 1%/Neomycin 3.5 mg/ml/Gentamicin 1 mg/ml/Polymyxin B 10,000 U/ml/Acetic Acid Otic Solution (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

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