Date:

18/08/2022

Category of the compound:

Pain

Name of the patient:

Active Pharmaceutical Ingredients:

  • 5% Ketamine Hcl
  • 5% Amitriptyline Powder
  • 5% Lidocaine Powder
  • 2% Cyclobenzaprine powder
  • 73% Lipoderm
  • 5% Gabapentin Powder
  • 5% Ketoprofen Powder

Quantity:

SIG:

Refills:

Prescribing Doctor Name: