Date:

18/10/2021

Category of the compound:

Pain

Name of the patient:

Active Pharmaceutical Ingredients:

  • 5% Ketamine Hcl
  • 2% Amitriptyline Powder
  • 10% Gabapentin Powder
  • 0.2% Clonidine powder
  • 2% Baclofen Powder
  • 2% Lidocaine Powder
  • 78.8% Lipoderm

Quantity:

SIG:

Refills:

Prescribing Doctor Name: