Address: City/State/Zip: Phone:
3844 Post Road, Warwick RI 02886 www.bayviewrx.com 401-284-4505 Phone 401-284-4506 Fax
Patient will pick up at pharmacy Please ship to patient
Anal Pain Formulations
Hemorrhoids H1 Hydrocortisone 2% / Lidocaine 3% Rectal Rocket Suppository H2 Hydrocortisone 2% / Lidocaine 1% Topical Ointment Anal Fissure / Thrombosed External Hemorrhoids
D12 Ditiazem 2% Topical Gel N5 Nifedipine 0.2% Rectal Ointment N6 Nitroglycerin 0.125% Topical Ointment N7 Nitroglycerin 0.2% Topical Ointment N9 Nitroglycerin 0.3% Topical Ointment N10 Nitroglycerin / Lidocaine 0.4-2% Topical Ointment Other Compound
Sig (Ointment): Apply 2-3 times per day. Sig (Rectal Rocket): Insert one suppository QHS x 5 nights. Alt Sig: Qty (ointment): 30 gms Qty (Rectal Rocket): 5 ea Refills: 0 1 2 3 4 5 6 7 8 9 10 11 12 NR 4
For professional use only. Bayview Pharmacy specializes in customizing medications to meet unique patient and prescriber needs. Above are examples of some commonly prescribed formulations across a diverse array of specialties, and is not meant to encourage the use of any formula contained within. Please apply your professional judgement within the scope of your specialty when prescribing. Bayview Pharmacy dispenses only to individually identified patients with valid prescriptions. No compounded medication is reviewed by the FDA for safety or efficacy. Bayview Pharmacy does not compound copies of commercially available products.