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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

CheckboxClotrimazole 2%/Urea 10% Compound Nail Solution

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Adding

Radio 3

CheckboxCoal Tar Topical Solution 10%/Betamethasone Dipropionate 0.025% Topical Cream

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Adding

Radio 3

CheckboxCoal Tar Topical Solution 10%/Betamethasone Dipropionate 0.025% Topical Gel

Add

Adding

Radio 3

CheckboxClotrimazole 2%/Ibuprofen 2%/Tea Tree Oil 5% Topical Cream

Add

Adding

Radio 3

CheckboxClotrimazole 10 mg/Betamethasone 0.75 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxClotrimazole 10 mg Capsules

Add

Adding

Radio 3

CheckboxCoal Tar Topical Solution 2%/Miconazole 2%/Selenium Sulfide 2%/Triamcinolone 0.1% Shampoo

Add

Adding

Radio 3

CheckboxCoal Tar Topical Solution 3% Soapless Shampoo

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Adding

Radio 3

CheckboxClotrimazole 2%/Ibuprofen 2%/Bacitracin 500 U/Gm/Deoxy-D-Glucose 0.2% Topical Ointment

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Adding

Radio 3

CheckboxCoal Tar Topical Solution 2%/Salicylic Acid 2% Scalp Solution

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Adding

Radio 3

CheckboxClotrimazole 2%/Ibuprofen 2%/Tea Tree Oil 1% Topical Cream

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Adding

Radio 3

CheckboxClotrimazole 1% Oral Rinse

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Adding

Radio 3

CheckboxClonidine HCl 6.25 mcg Troche

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Adding

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CheckboxClotrimazole 0.1%/Triamcinolone 0.025%/Urea 20% Topical Cream

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Adding

Radio 3

CheckboxClonidine HCl 0.1 mg/ml Oral Solution

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Adding

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CheckboxClonazepam 1 mg/ml Sublingual Drops

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Adding

Radio 3

CheckboxClotrimazole 1%/Gentamicin 0.3% Otic Solution

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Adding

Radio 3

CheckboxClomipramine HCl 5 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxClomipramine HCl 5 mg/ml Oral Suspension (Vet)

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Adding

Radio 3

CheckboxClonidine HCl 0.1% Topical Gel

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Adding

Radio 3

CheckboxClonidine HCl 0.1 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxClonidine HCl 0.2 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxClonidine HCl 0.1 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxClonazepam 0.1 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxClotrimazole 1%/Ciprofloxacin 0.3% Otic Solution

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Adding

Radio 3

CheckboxClomipramine HCl 50 mg/ml Nasal Solution

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Adding

Radio 3

CheckboxClotrimazole 1%/Ciprofloxacin 0.3%/Dexamethasone 0.1% Otic Solution

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Adding

Radio 3

CheckboxClomipramine HCl 5 mg/ml Oral Solution (Vet)

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Adding

Radio 3

CheckboxClonazepam 0.5 mg Troche

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Adding

Radio 3

CheckboxClomipramine HCl 5 mg/0.1 ml Topical Cream (Vet)

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Adding

Radio 3

CheckboxClotrimazole 1%/Gentamicin 0.3%/Betamethasone Valerate 0.12% Otic Gel (Vet)

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Adding

Radio 3

CheckboxClotrimazole 1 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxClotrimazole 1% Oral Adhesive Paste

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Adding

Radio 3

CheckboxClonidine HCl 20 mcg/ml Oral Suspension

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Adding

Radio 3

CheckboxClotrimazole 1%/DMSO 10% Topical Solution

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Adding

Radio 3

CheckboxClobetasol Propionate 0.05%/Zinc Pyrithione 0.2% Topical Foam

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Adding

Radio 3

CheckboxClomiphene Citrate 5% Topical Cream

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Adding

Radio 3

CheckboxClomiphene Citrate 2.5% Topical Gel

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Adding

Radio 3

CheckboxClomiphene Citrate 12.5 mg/Zinc Gluconate 7 mg/Anastrozole 0.1 mg Capsules

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Adding

Radio 3

CheckboxClomiphene Citrate 2.5%/Testosterone 2.5% Topical Gel

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Adding

Radio 3

CheckboxClomiphene Citrate 5%/Testosterone 5% Topical Cream

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Adding

Radio 3

CheckboxClomiphene Citrate 2.5%/Testosterone 2.5% Topical Cream

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Adding

Radio 3

CheckboxClindamycin 200 mg/Betamethasone 0.5 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxClobetasol Propionate 0.05% Topical/Vaginal Gel

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Adding

Radio 3

CheckboxClomiphene Citrate 12.5 mg/0.2 ml Sublingual Drops

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Adding

Radio 3

CheckboxClobetasol Propionate 0.05%/Lidocaine Hydrochloride 1% Oral Gel

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Adding

Radio 3

CheckboxClobetasol Propionate 0.05% Oral Rinse

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Radio 3

CheckboxClobetasol Propionate 8% Topical Nail Gel

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Adding

Radio 3

CheckboxClioquinol 3%/Hydrocortisone 1%/Pramoxine HCl 0.5% Topical Cream

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Adding

Radio 3

CheckboxClomiphene Citrate 12.5 mg/Testosterone 12.5 mg/0.2 ml Sublingual Drops

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Adding

Radio 3

CheckboxClomiphene Citrate 5% Topical Solution

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Adding

Radio 3

CheckboxClobetasol Propionate 0.05% Topical Foam

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Adding

Radio 3

CheckboxClomiphene Citrate 25 mg Capsules

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Adding

Radio 3

CheckboxClomiphene Citrate 5%/Testosterone 5% Topical Gel

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Adding

Radio 3

CheckboxClomiphene Citrate 2.5% Topical Solution

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Adding

Radio 3

CheckboxClioquinol 3%/Hydrocortisone 1% Topical Ointment

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Adding

Radio 3

CheckboxClomiphene Citrate 2.5% Topical Cream

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Adding

Radio 3

CheckboxClioquinol 1%/Hydrocortisone 1% Otic Suspension

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Adding

Radio 3

CheckboxClioquinol 3%/Hydrocortisone 1% Topical Cream

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Radio 3

CheckboxClindamycin 150 mg Suppository

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Adding

Radio 3

CheckboxClindamycin 150 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxClindamycin 1%/Tretinoin 0.025% Topical Cream

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Radio 3

CheckboxClindamycin 1%/Betamethasone Valerate 0.1% Topical Solution

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Radio 3

CheckboxClindamycin 1% Nasal Spray

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Radio 3

CheckboxClindamycin 150 mg/Levofloxacin 100 mg/Betamethasone 0.5 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxClindamycin 50 mg Capsules

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Adding

Radio 3

CheckboxClindamycin 30 mg/0.1 ml Topical Cream (Vet)

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Adding

Radio 3

CheckboxClindamycin 150 mg/Itraconazole 40 mg/Betamethasone 0.5 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxClindamycin 30 mg/Budesonide 0.6 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxClindamycin 3%/Doxycycline 1% Topical Ointment

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Radio 3

CheckboxClindamycin 30 mg Capsules

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Adding

Radio 3

CheckboxClindamycin 2%/Triamcinolone Acetonide 0.1% Nasal Gel

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Adding

Radio 3

CheckboxClindamycin 1%/Tretinoin 0.025% Topical Gel

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Adding

Radio 3

CheckboxClindamycin 1%/Lidocaine 1%/Naltrexone HCl 1%/Clobetasol Propionate 0.05% Topical Gel

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Adding

Radio 3

CheckboxClindamycin 150 mg/Tobramycin 125 mg/Betamethasone 0.5 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxClindamycin 1 mg/Gm/Gentamicin 1 mg/Gm/Polymyxin B 2,000 U/Gm Topical Gel

Add

Adding

Radio 3

CheckboxClindamycin 100 mg/Vitamin E 200 IU Vaginal Suppository

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Adding

Radio 3

CheckboxClindamycin 1 mg/ml/Gentamicin 1 mg/ml/Polymyxin B 2,000 U/ml Bladder Irrigation Solution

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Adding

Radio 3

CheckboxCiprofloxacin 2%/Itraconazole 2% Topical Gel (Vet)

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Adding

Radio 3

CheckboxCitric Acid 39.5% Dental Gel

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Adding

Radio 3

CheckboxCiprofloxacin 90 mg/Mupirocin 20 mg/Fluconazole 15 mg/Betamethasone 0.75 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxCisapride 10 mg/ml Oral Suspension (Vet)

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Adding

Radio 3

CheckboxCitric Acid 20% Shampoo

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Adding

Radio 3

CheckboxCiprofloxacin 90 mg/Fluconazole 15 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxCiprofloxacin 90 mg/Clotrimazole 10 mg/Betamethasone 0.75 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxCisapride 10 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxCiprofloxacin 90 mg/Fluconazole 15 mg/Betamethasone 0.75 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxCiprofloxacin 90 mg/Mupirocin 20 mg/Clotrimazole 10 mg/Betamethasone 0.75 mg Capsules (For Nasal Irrigation/Nebulizer)

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Adding

Radio 3

CheckboxCiprofloxacin 250 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxCiprofloxacin 90 mg Capsules

Add

Adding

Radio 3

CheckboxCisapride 5 mg Capsules (Vet)

Add

Adding

Radio 3

CheckboxCiprofloxacin 2%/Ketoconazole 1% Otic Gel

Add

Adding

Radio 3

CheckboxClarithromycin 100 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxCitric Acid 4% Dental Gel

Add

Adding

Radio 3

CheckboxCiprofloxacin 50 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxCisapride 1 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxCiprofloxacin 2% Vaginal Gel

Add

Adding

Radio 3

CheckboxCiprofloxacin 2%/Ketoconazole 2% Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxCiprofloxacin 90 mg/Clotrimazole 10 mg Capsules (For Nasal Irrigation/Nebulizer)

Add

Adding

Radio 3

CheckboxCisapride 2.5 mg/0.1 ml Topical Cream (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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