How to write a Compounded RX
Examples of Custom Prescriptions Sheets
Available for Local Georgia Physicians
 
 
Patients Name________________________________________DOB__________

Address_____________________________________________Date__________

             Compound
Generic Name (of medication or Ingredients)        Strength, Percent, Weight or Volume                             Repeat above if multiple ingredients

Quantity to dispense

                   Sig:

Refills____                                                                Prescribers Signature
Always include the order to compound
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We also provide Custom Compounded Prescription Sheets for Local Georgia Physicians.  Each sheet will have a location map of Partners In Care on the back of the sheet.  Below are some examples of the sheet layouts.  Remember that each sheet is tailored to your practice and prescribing needs.  If you are interested in a Custom Compounded Sheet for you practice fax your requirement and address to 770-536-2635.