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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

Last

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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

CheckboxNitrofurazone 0.2% Topical Solution

Add

Adding

Radio 3

CheckboxNifedipine 10 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxNifedipine 16% Topical Cream

Add

Adding

Radio 3

CheckboxNitrofurazone 6 mg Vaginal Suppository

Add

Adding

Radio 3

CheckboxNifedipine 4% Topical Cream

Add

Adding

Radio 3

CheckboxNifedipine 4 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxNitrofurazone 4.2 mg Vaginal Suppository

Add

Adding

Radio 3

CheckboxNifedipine 10 mg/ml Topical Gel

Add

Adding

Radio 3

CheckboxNifedipine 160 mg/ml Topical Gel

Add

Adding

Radio 3

CheckboxNortriptyline 25 mg/5 ml Oral Syrup

Add

Adding

Radio 3

CheckboxNitrofurazone 0.02%/Phenylephrine HCl 0.25% Nasal Solution

Add

Adding

Radio 3

CheckboxNifedipine 80 mg/ml Topical Gel

Add

Adding

Radio 3

CheckboxNitrofurantoin 10 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxNitrofurazone 0.2% Topical Ointment

Add

Adding

Radio 3

CheckboxNitroglycerin 0.2% Topical Ointment

Add

Adding

Radio 3

CheckboxNiacinamide 5%/Biotin 0.1%/Potassium Azeloyl Diglycinate 6% Topical Cream

Add

Adding

Radio 3

CheckboxNicotinamide Adenine Dinucleotide Na2 Reduced 10 mg Slow Release Ar Capsules

Add

Adding

Radio 3

CheckboxNiacinamide 4%/Tretinoin 0.05%/Clobetasol Propionate 0.025% Topical Cream

Add

Adding

Radio 3

CheckboxNifedipine 0.2% Suppository

Add

Adding

Radio 3

CheckboxNiacinamide 4%/Tretinoin 0.05%/Glycolic Acid 2.5% Topical Gel

Add

Adding

Radio 3

CheckboxNiacinamide 4%/Salicylic Acid 3%/Terbinafine HCl 1% Topical Gel

Add

Adding

Radio 3

CheckboxNiacinamide 5%/Ivermectin 1%/Potassium Azeloyl Diglycinate 15% Topical Cream

Add

Adding

Radio 3

CheckboxNiacinamide 4%/Ivermectin 1% Topical Cream

Add

Adding

Radio 3

CheckboxNifedipine 1 mg/0.25 ml Sublingual Liquid

Add

Adding

Radio 3

CheckboxNiacinamide 25 mg/Iodine 103 mg Capsules

Add

Adding

Radio 3

CheckboxNicotinamide Adenine Dinucleotide Na2 Reduced 5 mg Slow Release Ar Capsules

Add

Adding

Radio 3

CheckboxNiacinamide 4%/Metronidazole 1% Topical Cream

Add

Adding

Radio 3

CheckboxNiacinamide 5%/Kojic Acid 4% Topical Cream

Add

Adding

Radio 3

CheckboxNiacinamide 250 mg/Acetylcysteine 100 mg Capsules

Add

Adding

Radio 3

CheckboxNiacinamide 5%/Biotin 0.1%/Potassium Azeloyl Diglycinate 6% Topical Gel

Add

Adding

Radio 3

CheckboxNiacinamide 5%/Potassium Azeloyl Diglycinate 15% Topical Cream

Add

Adding

Radio 3

CheckboxNifedipine 2 mg/0.25 ml Sublingual Liquid

Add

Adding

Radio 3

CheckboxNifedipine 0.2% Rectal Ointment

Add

Adding

Radio 3

CheckboxNiacinamide 5%/Lipoic Acid 1%/Biotin 0.1% Topical Cream

Add

Adding

Radio 3

CheckboxNiacinamide 4%/Clindamycin 1%/Tretinoin 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxNeomycin 3.5 mg/Gm/Polymyxin B 5000 U/Gm/Bacitracin 400 U/Gm Topical Powder

Add

Adding

Radio 3

CheckboxNiacinamide 4%/Ivermectin 1%/Metronidazole 0.75% Topical Gel

Add

Adding

Radio 3

CheckboxNeomycin 3.5 mg/Gm/Polymyxin B 5000 U/Gm/Bacitracin 500 U/Gm Topical Ointment

Add

Adding

Radio 3

CheckboxNiacinamide 4%/Biotin 0.1%/Lipoic Acid 0.5% Topical Gel

Add

Adding

Radio 3

CheckboxNeomycin 49 mg/Methscopolamine Bromide 1 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxNiacinamide 2%/Minoxidil 1%/Hyaluronic Acid Scalp Solution

Add

Adding

Radio 3

CheckboxNiacinamide 2%/Tranexamic Acid 2% Topical Cream

Add

Adding

Radio 3

CheckboxNiacinamide 4% Topical Gel

Add

Adding

Radio 3

CheckboxNeomycin 17.5 mg/ml Oral Solution

Add

Adding

Radio 3

CheckboxNiacin 50 mg/Meclizine HCl 12.5 mg Capsules

Add

Adding

Radio 3

CheckboxNeomycin 35 mg/ml/Methscopolamine Bromide 0.25 mg/ml Oral Drops (Vet)

Add

Adding

Radio 3

CheckboxNiacin 250 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxNeomycin 35 mg/ml Oral Drops (Vet)

Add

Adding

Radio 3

CheckboxNeomycin 35 mg/Methscopolamine Bromide 0.5 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxNiacinamide 2%/Clindamycin 1% Topical Foam

Add

Adding

Radio 3

CheckboxNiacinamide 3%/Lipoic Acid 0.5% Topical Cream

Add

Adding

Radio 3

CheckboxNiacinamide 4% Topical Cream

Add

Adding

Radio 3

CheckboxNiacin 50 mg/Meclizine HCl 25 mg Capsules

Add

Adding

Radio 3

CheckboxNeomycin 0.35% Rectal Enema

Add

Adding

Radio 3

CheckboxNaproxen 375 mg/5 ml Oral Suspension

Add

Adding

Radio 3

CheckboxNaproxen 125 mg/5 ml Oral Suspension

Add

Adding

Radio 3

CheckboxNaproxen 375 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxNaproxen 500 mg Suppository

Add

Adding

Radio 3

CheckboxNaproxen 500 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxNaproxen Sodium 550 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxNeomycin 3.5 mg/Gm/Polymyxin B 10,000 U/Gm/Gramicidin 0.25 mg/Gm Topical Cream

Add

Adding

Radio 3

CheckboxNaproxen 250 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxNaproxen Sodium 275 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxNeomycin 3.5 mg/Gm Topical Ointment

Add

Adding

Radio 3

CheckboxNeomycin 0.35%/Methylprednisolone Acetate 0.25% Topical Ointment

Add

Adding

Radio 3

CheckboxNaproxen 375 mg Suppository

Add

Adding

Radio 3

CheckboxNaproxen 250 mg Suppository

Add

Adding

Radio 3

CheckboxNaproxen 15% Topical Gel

Add

Adding

Radio 3

CheckboxNeomycin 0.35 mg/ml/Gentamicin 0.08 mg/ml/Polymyxin B 100 U/ml Bladder Irrigation

Add

Adding

Radio 3

CheckboxNaproxen Sodium 220 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxNaproxen 250 mg/5 ml Oral Suspension

Add

Adding

Radio 3

CheckboxNeomycin 0.35%/Dexamethasone 0.06% Topical Ointment

Add

Adding

Radio 3

CheckboxNaproxen 5% Topical Gel

Add

Adding

Radio 3

CheckboxNaltrexone HCl 1%/Ketotifen 0.05% Topical Gel

Add

Adding

Radio 3

CheckboxNaproxen 10% Topical Gel

Add

Adding

Radio 3

CheckboxNaltrexone HCl 4 mg Capsules

Add

Adding

Radio 3

CheckboxNaltrexone HCl 4.5 mg Capsules

Add

Adding

Radio 3

CheckboxNaltrexone HCl 5 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxNaltrexone HCl 1%/Doxepin HCl 0.5% Topical Cream

Add

Adding

Radio 3

CheckboxNaltrexone HCl 1%/Ketotifen 0.05% Topical Cream

Add

Adding

Radio 3

CheckboxNaltrexone HCl 100 mg/ml Topical Cream

Add

Adding

Radio 3

CheckboxNaltrexone HCl 50 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxNaltrexone HCl 10 mg/ml Oral Solution

Add

Adding

Radio 3

CheckboxNaltrexone HCl 1%/Pramoxine HCl 1% Topical Gel

Add

Adding

Radio 3

CheckboxNaltrexone HCl 5 mg/60 ml Rectal Suspension Enema

Add

Adding

Radio 3

CheckboxNaltrexone HCl 5 mg Capsules

Add

Adding

Radio 3

CheckboxNaltrexone HCl 100 mg/ml Topical Gel

Add

Adding

Radio 3

CheckboxNaltrexone HCl 3 mg Capsules

Add

Adding

Radio 3

CheckboxNaltrexone HCl 0.25 mg Capsules

Add

Adding

Radio 3

CheckboxNaltrexone HCl 0.5% Nasal Spray

Add

Adding

Radio 3

CheckboxNadolol 20 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxNadolol 10 mg/ml Oral Suspension

Add

Adding

Radio 3

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

Add

Adding

Radio 3

CheckboxNaltrexone HCl 1.5 mg Capsules

Add

Adding

Radio 3

CheckboxNaltrexone HCl 0.5 mg/Sodium Butyrate Slow Release Ar Capsules

Add

Adding

Radio 3

CheckboxNadolol 20 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxNaltrexone HCl 0.5%/Azelastine HCl 0.175% Nasal Spray

Add

Adding

Radio 3

CheckboxNaltrexone HCl 1% Topical Cream

Add

Adding

Radio 3

CheckboxNaltrexone HCl 1% Topical Gel

Add

Adding

Radio 3

CheckboxNaltrexone HCl 0.5% Otic Solution

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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