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Test Print
Test Print
Compounded Hormone Replacement Therapy
Hidden
CHTID:
MRN #:
*
Type of CHT Prescription:
Standard
Prescription Pad
Hidden
Patient Id Hidden
Hidden
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Select dosage form:
*
Transdermal
Oral
Sublingual (Troches)
Vulvovaginal
Intravaginal
Release options for capsules:
*
Regular Release
Altered Release
Prescription Pad:
Directions for use:
*
Apply 1 ml once daily and rub in well
Apply 0.5 ml twice daily and rub in well
Specific to cycled Progesterone: Apply 0.5 ml twice daily on days 10 to 20 of cycle and rub in well
Specific to cycled Progesterone: Take 1 capsule or troche twice daily on days 10 to 20 of cycle
Specific to cycled Progesterone: Apply 0.5 ml twice daily on days 16 to 25 of cycle and rub in well
Specific to cycled Progesterone: Take 1 capsule or troche twice daily on days 16 to 25 of cycle
Specific to cycled Progesterone: Apply 0.5 ml once daily on days 1 to 15 of cycle, then 0.5 ml twice daily on days 16 to 25 of cycle, then stop on days 26 to 28 and rub in well
Specific to cycled progesterone: Take 1 capsule or troche once daily on days 1 to 15 of cycle, then 1 capsule or troche twice daily on days 16 to 25 of cycle, then stop on days 26 to 28
Take 1 capsule daily
Take 1 capsule daily at bedtime
Take 1 capsule twice daily
Dissolve 1 troche in mouth once daily
Dissolve 1/2 troche in mouth twice daily
Apply 1 ml vulvovaginally once daily
Apply 1 ml vulvovaginally twice daily for one week, then once daily for one week, then 2-3 time weekly thereafter
Insert 1 ml intravaginally once daily
Insert 1 ml intravaginally 2 to 3 times weekly
Click desired hormone(s) and strength(s):
Estradiol
[none]
0.15 mg per gram or capsule or troche
0.25 mg per gram or capsule or troche
0.35 mg per gram or capsule or troche
0.5 mg per gram or capsule or troche
0.75 mg per gram or capsule or troche
1 mg per gram or capsule or troche
1.5 mg per gram or capsule or troche
2 mg per gram or capsule or troche
2.5 mg per gram or capsule or troche
Biest (50/50)
[none]
0.15 mg per gram or capsule or troche
0.25 mg per gram or capsule or troche
0.35 mg per gram or capsule or troche
0.5 mg per gram or capsule or troche
0.75 mg per gram or capsule or troche
1 mg per gram or capsule or troche
1.25 mg per gram or capsule or troche
1.5 mg per gram or capsule or troche
1.75 mg per gram or capsule or troche
2 mg per gram or capsule or troche
2.5 mg per gram or capsule or troche
3 mg per gram or capsule or troche
5 mg per gram or capsule or troche
Biest (20/80)
[none]
0.15 mg per gram or capsule or troche
0.25 mg per gram or capsule or troche
0.35 mg per gram or capsule or troche
0.5 mg per gram or capsule or troche
0.75 mg per gram or capsule or troche
1 mg per gram or capsule or troche
1.25 mg per gram or capsule or troche
1.5 mg per gram or capsule or troche
1.75 mg per gram or capsule or troche
2 mg per gram or capsule or troche
2.5 mg per gram or capsule or troche
3 mg per gram or capsule or troche
5 mg per gram or capsule or troche
Estriol
[none]
1 mg per gram or capsule or troche
1.25 mg per gram or capsule or troche
1.5 mg per gram or capsule or troche
2 mg per gram or capsule or troche
2.5 mg per gram or capsule or troche
0.1% (for intravaginal use)
0.2% (for intravaginal use)
0.3% (for intravaginal use)
Progesterone
[none]
10 mg per gram or capsule or troche
15 mg per gram or capsule or troche
25 mg per gram or capsule or troche
35 mg per gram or capsule or troche
50 mg per gram or capsule or troche
65 mg per gram or capsule or troche
75 mg per gram or capsule or troche
85 mg per gram or capsule or troche
100 mg per gram or capsule or troche
125 mg per gram or capsule or troche
150 mg per gram or capsule or troche
175 mg per gram or capsule or troche
200 mg per gram or capsule or troche
Testosterone (Female)
[none]
0.15 mg per gram or capsule or troche
0.25 mg per gram or capsule or troche
0.35 mg per gram or capsule or troche
0.5 mg per gram or capsule or troche
0.65 mg per gram or capsule or troche
0.75 mg per gram or capsule or troche
1 mg per gram or capsule or troche
1.5 mg per gram or capsule or troche
2 mg per gram or capsule or troche
2.5 mg per gram or capsule or troche
1% (for vulvovaginal use)
2% (for vulvovaginal use)
Testosterone (Male)
[none]
5 mg per gram or capsule or troche
10 mg per gram or capsule or troche
15 mg per gram or capsule or troche
25 mg per gram or capsule or troche
75 mg per gram or capsule or troche
100 mg per gram or capsule or troche
150 mg per gram or capsule or troche
175 mg per gram or capsule or troche
200 mg per gram or capsule or troche
DHEA (Female)
[none]
1 mg per gram or capsule or troche
2 mg per gram or capsule or troche
2.5 mg per gram or capsule or troche
3 mg per gram or capsule or troche
5 mg per gram or capsule or troche
10 mg per gram or capsule or troche
DHEA (Male)
[none]
2.5 mg per gram or capsule or troche
5 mg per gram or capsule or troche
7.5 mg per gram or capsule or troche
10 mg per gram or capsule or troche
15 mg per gram or capsule or troche
25 mg per gram or capsule or troche
50 mg per gram or capsule or troche
100 mg per gram or capsule or troche
Pregnenolone
[none]
5 mg per gram or capsule or troche
10 mg per gram or capsule or troche
25 mg per gram or capsule or troche
50 mg per gram or capsule or troche
75 mg per gram or capsule or troche
100 mg per gram or capsule or troche
