Date:

18/08/2022

Category of the compound:

Pain

Name of the patient:

Active Pharmaceutical Ingredients:

  • 2% Ketamine Hel
  • 5% Baclofen Powder
  • 73% Lipoderm
  • 20% Diclofenac Powder

Quantity:

SIG:

Refills:

Prescribing Doctor Name: