Date:

18/08/2022

Category of the compound:

Pain

Name of the patient:

Active Pharmaceutical Ingredients:

  • 10% Ketamine Hcl
  • 0.2% Clonidine powder
  • 10% Ketoprofen Powder
  • 6% Gabapentin Powder
  • 10% Lidocaine Powder
  • 63.8% Lipoderm

Quantity:

SIG:

Refills:

Prescribing Doctor Name: