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


Generic Name (of medication or ingredients)        Strength, Percent, Weight or Volume

Repeat above if multiple ingredients

Quantity to dispense


Refills____                   Prescribers Signature_______________________________

Always include the order to compound


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.  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 requirements and address to 770-536-2635.