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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.

Need help?

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

CheckboxEnalapril Maleate 15 mg Capsules

Add

Adding

Radio 3

CheckboxEnalapril Maleate 5 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDoxylamine Succinate 10 mg/Pyridoxine HCl 50 mg Capsules

Add

Adding

Radio 3

CheckboxDuloxetine 5 mg Acid Resistant Capsules

Add

Adding

Radio 3

CheckboxDyclonine HCl 1% Topical Solution

Add

Adding

Radio 3

CheckboxDutasteride 0.5 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxDoxylamine Succinate 20 mg/Pyridoxine HCl 100 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxDoxycycline 100 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxDoxylamine Succinate 10 mg/Pyridoxine HCl 10 mg Suppository

Add

Adding

Radio 3

CheckboxDoxycycline 50 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxDuloxetine 10 mg Acid Resistant Capsules

Add

Adding

Radio 3

CheckboxDuloxetine 5 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxDoxycycline 50 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxDuloxetine 2 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxDoxycycline 100 mg/Biotin 5 mg Slow Release Acid Resistant Capsules

Add

Adding

Radio 3

CheckboxDoxylamine Succinate 10 mg/Pyridoxine HCl 10 mg Capsules

Add

Adding

Radio 3

CheckboxDoxylamine Succinate 10 mg/Pyridoxine HCl 10 mg Troche

Add

Adding

Radio 3

CheckboxDyclonine HCl 0.5% Topical Dental Solution

Add

Adding

Radio 3

CheckboxDoxycycline 200 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDyclonine HCl 1% Topical Dental Gel

Add

Adding

Radio 3

CheckboxDoxycycline 100 mg/Mupirocin 30 mg/Clotrimazole 30 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxDoxycycline 100 mg/Biotin 5 mg Capsules

Add

Adding

Radio 3

CheckboxDoxycycline 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxDocusate Sodium 200 mg Capsules

Add

Adding

Radio 3

CheckboxDoxepin HCl 4% Topical Cream

Add

Adding

Radio 3

CheckboxDoxycycline 10 mg/ml Oral Gel

Add

Adding

Radio 3

CheckboxDoxepin 75 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDocusate Sodium 100 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDoxycycline 20 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDoxepin 25 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDocusate Sodium 30 mg/ml Oral Syrup

Add

Adding

Radio 3

CheckboxDoxepin 100 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDoxepin HCl 0.5% Mouthwash

Add

Adding

Radio 3

CheckboxDoxycycline 30 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxDoxepin 50 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDoxycycline 20 mg/Phenytoin 20 mg/Lidocaine HCl 10 mg/Misoprostol 0.024 mg Wound Care Capsules

Add

Adding

Radio 3

CheckboxDoxepin 10 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDoxycycline 10 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxDocusate Sodium 283 mg/3.88 Gm Rectal Enema Solution

Add

Adding

Radio 3

CheckboxDoxycycline 10 mg/ml To 100 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxDoxycycline 40 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDoxepin HCl 2% Topical Gel

Add

Adding

Radio 3

CheckboxDoxycycline 30 mg/Clotrimazole 3 mg/Betamethasone 0.75 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxDoxepin 10 mg/ml Oral Solution (Gluten Free)

Add

Adding

Radio 3

CheckboxDoxepin HCl 0.5%/Naltrexone HCl 0.1% Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxDocusate Sodium 50 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDiphenylcyclopropenone 5% Topical Cream

Add

Adding

Radio 3

CheckboxDiphenylcyclopropenone 2% Topical Ointment

Add

Adding

Radio 3

CheckboxDocusate Sodium 1% Oral Solution

Add

Adding

Radio 3

CheckboxDiphenylcyclopropenone 0.01% Topical Solution

Add

Adding

Radio 3

CheckboxDiphenylcyclopropenone 1% Topical Solution

Add

Adding

Radio 3

CheckboxDipyridamole 25 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDipyridamole 75 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDipyridamole 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxDipyridamole 150 mg Capsules

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 100 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Naltrexone HCl 0.2% Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Naltrexone HCl 0.5%/Vitamin D3 5000 Iu/Gm Topical Gel

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 25% Topical Gel

Add

Adding

Radio 3

CheckboxDiphenylcyclopropenone 0.1% Topical Solution

Add

Adding

Radio 3

CheckboxDocusate Sodium 2% Otic Solution

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Pramoxine HCl 1%/Hydrocortisone 1% Topical Gel

Add

Adding

Radio 3

CheckboxDisulfiram 250 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 3%/Lidocaine 3%/Hydrocortisone 2.5% Topical Cream

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Naltrexone HCl 0.5%/Vitamin D3 5000 Iu/Gm Topical Cream

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Naltrexone HCl 0.5% Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxDiphenylcyclopropenone 2% Topical Solution

Add

Adding

Radio 3

CheckboxDisulfiram 125 mg Capsules

Add

Adding

Radio 3

CheckboxDipyridamole 50 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxDocusate Sodium 14.1%/Benzocaine 1% Rectal Enema

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Camphor 3%/Menthol 1% Topical Cream

Add

Adding

Radio 3

CheckboxDiindolylmethane 6% Topical Cream

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 1%/Calamine 8% Topical Cream

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Hydrocortisone 0.5% Topical Cream

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 0.1%/Misoprostol 0.0024% Oral Rinse

Add

Adding

Radio 3

CheckboxDimercaptosuccinic Acid 250 mg Capsules

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Hydrocortisone 1%/Aloe Vera 0.5% Topical Gel

Add

Adding

Radio 3

CheckboxDimercaptosuccinic Acid 100 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2.5%/Diclofenac Sodium 2% Topical Gel

Add

Adding

Radio 3

CheckboxDiltiazem HCl 2% Topical Ointment

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2.5 mg/ml/Nystatin 12,500 Units/ml/Hydrocortisone 0.25 mg/ml Mouthwash

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Hydrocortisone 1%/Aloe Vera 0.5% Topical Cream

Add

Adding

Radio 3

CheckboxDimercaptosuccinic Acid 50 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxDimercaptosuccinic Acid 150 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 1%/Ketotifen 0.05% Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Lidocaine HCl 1%/Dexamethasone Sodium Phosphate 0.05% Topical Spray

Add

Adding

Radio 3

CheckboxDimercaptosuccinic Acid 500 mg Capsules

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 2%/Hydrocortisone 1% Topical Cream

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 1%/Naltrexone HCl 0.5% Topical Cream

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 1%/Dexamethasone Sodium Phosphate 0.05% Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxDimercaptosuccinic Acid 200 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxDiphenhydramine HCl 1% Topical Ointment

Add

Adding

Radio 3

CheckboxDiltiazem 75 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxDihydroergotamine Mesylate 3 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxDihydroergotamine Mesylate 5 mg/Promethazine HCl 50 mg/Caffeine 100 mg Suppository

Add

Adding

Radio 3

CheckboxDiflorasone Diacetate 0.035%/Nystatin 30,000 U/Gm Topical Ointment

Add

Adding

Radio 3

CheckboxDihydroergotamine Mesylate 0.25% Nasal Spray

Add

Adding

Radio 3

CheckboxDiclofenac Sodium 50 mg Acid Resistant Capsules

Add

Adding

Radio 3

CheckboxDihydroergotamine Mesylate 2 mg/0.5 ml Topical Gel

Add

Adding

Radio 3

CheckboxDihydroergotamine Mesylate 2.5 mg/ml Nasal Spray

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.

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