Order Form Builder | Technician Dashboard | Bayview Pharmacy | Your Compounding Pharmacy of Choice

Home

Prescribe

Your Order Form

Compound Catalog Popular Order Forms

Staff

Compound Catalog

Order Form w/ Formulas

Custom Order Form Popular Order Forms Send Order Forms Documents Hospice SOPs Peptides Tests

Prescribers

Tutorials

Settings

My Account Support Log Out

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

Optimized for desktop use.
Please view on a larger screen to use this tool.

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

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

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)

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Menthol 0.5% Scalp Lotion

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Nystatin 2000 U/Gm/Mupirocin 2%/Boric Acid Otic Powder

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Glycolic Acid 30% Topical Lotion

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Gentamicin 3.2 mg/ml/Polymyxin B 10,000 U/ml Otic Solution (Vet)

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Nystatin 33,333 Units/Gm/Zinc Oxide Topical Ointment

Add

Adding

Radio 3

CheckboxHydrocortisone 2.5 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Zinc Oxide 0.5% Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 2.5 mg Capsules

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Neomycin 0.35% Otic Suspension

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Neomycin 3.5 mg/ml/Polymyxin B 10,000 U/ml Otic Solution

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Neomycin 3.5 mg/ml/Polymyxin B 10,000 U/ml Otic Suspension

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Lidocaine HCl 0.5%/Neomycin 0.35%/Polymyxin B 10,000 U/ml Otic Solution

Add

Adding

Radio 3

CheckboxHydrocortisone 2 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Benzoyl Peroxide 5% Topical Lotion

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Salicylic Acid 0.5% Scalp Lotion

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Neomycin 10 mg/ml/Benzocaine 0.5%/Polymyxin B 3000 U/ml/Bacitracin 500 U/ml Oral Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Neomycin 3.5 mg/ml/Gentamicin 1.7 mg/ml/Polymyxin B 10,000 U/ml Otic Solution

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Menthol 0.5% Topical Gel

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Neomycin 3.5 mg/Gm/Polymyxin B 10,000 U/Gm Topical Cream

Add

Adding

Radio 3

CheckboxGuaifenesin 500 mg Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 1%/Acetic Acid 2% Otic Solution

Add

Adding

Radio 3

CheckboxHydrocodone Bitartrate 5 mg/Acetaminophen 500 mg Suppository

Add

Adding

Radio 3

CheckboxHydrocortisone 0.5%/Clioquinol 2% Suppository

Add

Adding

Radio 3

CheckboxHaloperidol 0.06 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxHaloperidol 2 mg/ml Oral Solution (Gluten Free/Flavored)

Add

Adding

Radio 3

CheckboxHydrocodone Bitartrate 20 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxHydrocortisone 0.6%/Salicylic Acid 0.48% Topical Solution

Add

Adding

Radio 3

CheckboxHaloperidol 1% Topical Solution

Add

Adding

Radio 3

CheckboxHydrocortisone 1 mg/ml To 20 mg/ml Oral Suspension

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.