Date:

17/05/2021

Category of the compound:

Pain

Name of the patient:

Active Pharmaceutical Ingredients:

  • 10% Ketamine Hcl
  • 10% Lidocaine Powder
  • 6% Gabapentin Powder
  • 10% Ketoprofen Powder
  • 64% Lipoderm

Quantity:

SIG:

Refills:

Prescribing Doctor Name: