Date:

18/10/2021

Category of the compound:

Pain

Name of the patient:

Active Pharmaceutical Ingredients:

  • 5% Ketamine Hcl
  • 4% Baclofen Powder
  • 10% Diclofenac Powder
  • 4% Amitriptyline Powder
  • 77% Lipoderm

Quantity:

SIG:

Refills:

Prescribing Doctor Name: