Date:

18/08/2022

Category of the compound:

Pain

Name of the patient:

Active Pharmaceutical Ingredients:

  • 5% Ketamine Hcl
  • 12% Lidocaine Powder
  • 10% Gabapentin Powder
  • 73% Lipoderm ActiveMax

Quantity:

SIG:

Refills:

Prescribing Doctor Name: