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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.

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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

CheckboxAcyclovir 10% Flavored Lip Ointment

Add

Adding

Radio 3

CheckboxAcyclovir 10%/Chlorhexidine Gluconate 2% Topical Gel

Add

Adding

Radio 3

CheckboxAcyclovir 7.5% Topical Ointment

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Adding

Radio 3

CheckboxAcyclovir 400 mg Capsules (Gluten Free)

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Adding

Radio 3

CheckboxAcetylcysteine 400 mg/Pyridoxal-5-Phosphate 25 mg/Calcium L-5 Methyltetrahydrofolate 8 mg/Methylcobalamin 2 mg Capsules

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Adding

Radio 3

CheckboxAcetylcysteine 435 mg Capsules

Add

Adding

Radio 3

CheckboxAcyclovir 5%/Imiquimod 2.5%/Tea Tree Oil 2.5%/Deoxy-D-Glucose

Add

Adding

Radio 3

CheckboxAcetylcysteine 200 mg/ml Oral Solution

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Adding

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CheckboxAcetylcysteine 100 mg Capsules (For Nasal Irrigation/Inhalation)

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Adding

Radio 3

CheckboxAcyclovir 2%/Deoxy-D-Glucose 0.2% Lip Balm

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Adding

Radio 3

CheckboxAcetylcysteine 245 mg Capsules

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Adding

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CheckboxAcetylcysteine 200 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxAcyclovir 5% Oral Adhesive Paste

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Adding

Radio 3

CheckboxAcyclovir 5%/Lidocaine 1% Lip Balm

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Adding

Radio 3

CheckboxAcyclovir 5%/Hydrocortisone 2.5%/Lidocaine 2% Topical Cream

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Adding

Radio 3

CheckboxAcyclovir 5%/Lidocaine 2% Topical Cream

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Adding

Radio 3

CheckboxAcyclovir 5% Lip Balm

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Adding

Radio 3

CheckboxAcetylcysteine 600 mg Capsules

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Adding

Radio 3

CheckboxAcetylcysteine 10%/Urea 10%/Rosemary Oil 10% Topical Gel

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Adding

Radio 3

CheckboxAcetylcysteine 44.17 mg/ml/Tobramycin 3 mg/ml Ophthalmic Solution

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Adding

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CheckboxAcetylcysteine 3%/Phenytoin 2%/Misoprostol 0.0024% Topical Gel

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Adding

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CheckboxAcetylcysteine 20% Topical Cream

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Adding

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CheckboxAcetylcysteine 5% Oral Solution (Vet)

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Adding

Radio 3

CheckboxAcetylcysteine 10%/Urea 10%/Rosemary Oil 1.5% Topical Cream

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Adding

Radio 3

CheckboxAcetylcysteine 5% Ophthalmic Solution

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Adding

Radio 3

CheckboxAcetylcysteine 10% Ophthalmic Solution

Add

Adding

Radio 3

CheckboxAcetylcysteine 10% Nasal Spray

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Adding

Radio 3

CheckboxAcetylcysteine 10% Topical Cream

Add

Adding

Radio 3

CheckboxAcetylcysteine 3% Topical Gel

Add

Adding

Radio 3

CheckboxAcetylcysteine 5% Topical Cream

Add

Adding

Radio 3

CheckboxAcetic Acid/Dyclonine 1% Topical Gel

Add

Adding

Radio 3

CheckboxAcetylcysteine 3.3%/Atropine Sulfate 0.33%/Gentamicin 0.1% Ophthalmic Solution (Vet)

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Adding

Radio 3

CheckboxAcetazolamide 150 mg/ml Oral Suspension (Vet-Equine)

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Adding

Radio 3

CheckboxAcetazolamide 250 mg Troche

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Adding

Radio 3

CheckboxAcetic Acid 0.921%/Hydroxyquinoline Sulfate 0.026% Vaginal Gel

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Adding

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CheckboxAcetazolamide 125 mg Rapid Dissolve Tablet

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Adding

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CheckboxAcetic Acid 2% in Aluminum Acetate Otic Solution

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Adding

Radio 3

CheckboxAcetazolamide 500 mg Slow Release Capsules

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Adding

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CheckboxAcetic Acid 5% Topical Gel

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Adding

Radio 3

CheckboxAcetic Acid 2.5%/Zinc Oxide 0.01 Molar Iontophoresis Solution

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Adding

Radio 3

CheckboxAcetic Acid 2% Ultrasound Gel

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Adding

Radio 3

CheckboxAcetaminophen 325 mg/Chloral Hydrate 100 mg/Isometheptene Mucate 65 mg Capsules

Add

Adding

Radio 3

CheckboxAcetaminophen 325 mg/Chloral Hydrate 65 mg/Isometheptene Mucate 65 mg Capsules

Add

Adding

Radio 3

CheckboxAcetaminophen 650 mg/Pseudoephedrine HCl 60 mg/Chlorpheniramine Maleate 4 mg Flu & Cold Oral Powder Packet

Add

Adding

Radio 3

CheckboxAcetaminophen 650 mg/Pseudoephedrine HCl 60 mg/Dextromethorphan HBr 20 mg/Chlorpheniramine Maleate 4 mg Flu, Cold & Cough Oral Powder Packet

Add

Adding

Radio 3

CheckboxAcetaminophen 325 mg/Chloral Hydrate 67 mg/Isometheptene Mucate 65 mg/Antipyrine 33 mg Capsules

Add

Adding

Radio 3

CheckboxAcetaminophen 325 mg/ml/Oxycodone HCl 5 mg/ml Concentrate Oral Suspension

Add

Adding

Radio 3

CheckboxAcetaminophen 325 mg/Oxycodone HCl 5 mg Capsules

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Adding

Radio 3

CheckboxAcetaminophen 1000m/15 ml Oral Suspension

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Adding

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CheckboxAcetazolamide 25 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxAcetaminophen 325 mg/Promethazine HCl 20 mg Suppository

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Adding

Radio 3

CheckboxAcetaminophen 325 mg/Isometheptene 65 mg/Hydroxyzine HCl 25 mg Capsules

Add

Adding

Radio 3

CheckboxAcetaminophen 21.67 mg/ml/Dextromethorphan HBr 0.67 mg/ml/Pseudoephedrine HCl 0.33 mg/ml Oral Syrup

Add

Adding

Radio 3

CheckboxAcetaminophen 250 mg Slow Release Capsules

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Adding

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CheckboxAcetaminophen 325 mg/5 ml Oral Suspension

Add

Adding

Radio 3

CheckboxAcetaminophen 80 mg - 325 mg Suppository

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Adding

Radio 3

CheckboxAcetaminophen 160 mg/5ml Oral Suspension

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Adding

Radio 3

CheckboxAcepromazine Maleate 25 mg/ml Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxAcetaminophen 5% Topical Gel

Add

Adding

Radio 3

CheckboxAcetaminophen 5% Topical Cream

Add

Adding

Radio 3

CheckboxAcetaminophen 24 mg/ml/Hydrocodone Bitartrate 0.5 mg/ml Oral Liquid

Add

Adding

Radio 3

CheckboxAcetaminophen 65 mg/ml/Oxycodone HCl 1 mg/ml Oral Syrup

Add

Adding

Radio 3

CheckboxAcetaminophen 24 mg/ml/Codeine Phosphate 2.4 mg/ml Oral Solution

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Adding

Radio 3

CheckboxAcetaminophen 120 mg/Aspirin 210 mg/Caffeine 30 mg Capsules

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Adding

Radio 3

CheckboxAcetaminophen 33.4 mg/ml/Hydrocodone Bitartrate 0.5 mg/ml Oral Liquid

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Adding

Radio 3

CheckboxAcetaminophen 325 mg/Caffeine 40 mg/Codeine Phosphate 30 mg/Phenobarbital 15 mg Capsules

Add

Adding

Radio 3

CheckboxAcetaminophen 125 mg Troche

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Adding

Radio 3

CheckboxAcetaminophen 32 mg/ml Oral Suspension

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Adding

Radio 3

CheckboxAcetaminophen 300 mg/Chlorpheniramine Maleate 2 mg/Pseudoephedrine HCl 30 mg/Guaifenesin 100 mg Suppository

Add

Adding

Radio 3

CheckboxAcetaminophen 100 mg/ml Oral Drops

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Adding

Radio 3

CheckboxAcepromazine Maleate 25 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxAcebutolol 250 mg Capsules

Add

Adding

Radio 3

CheckboxAcepromazine Maleate 5 mg/0.1 ml Topical Cream (Vet)

Add

Adding

Radio 3

CheckboxAcebutolol 300 mg Capsules

Add

Adding

Radio 3

CheckboxAcepromazine Maleate 5 mg/0.1ml Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxAcebutolol 100 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxPhenazopyridine HCl 150 mg/Butalbital 15 mg/Hyoscyamine Sulfate 0.3 mg Capsules

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!

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