Date:

18/08/2022

Category of the compound:

Pain

Name of the patient:

Active Pharmaceutical Ingredients:

  • 5% Ketamine Hcl
  • 5% Lidocaine Powder
  • 5% Amitriptyline Powder
  • 10% Ketoprofen Powder
  • 0.05% CAPSAICIN USP NATURAL
  • 74.95% Lipoderm

Quantity:

SIG:

Refills:

Prescribing Doctor Name: