MTM Summary 7/30/2021 through 8/6/2021

Arkadiusz Jachimowicz
Mandelblatt, Svetlana DOB: 09/18/1936 Age: 84 Gender: F

225068-1_BU3 5.00% DIMETHYL SULFOXIDE

Filled: 07/23/2021 5.00% GLYCERIN
Drug: Comp.p#7096.1 30.00% PROPYLENE GLYCOL
Strength: 60GM 3.00% BACLOFEN*
Notes: Apply To Affected Area 1 Gram Twice A Day Maximum 2 Grams 3.00% GABAPENTIN
Per Day 3.00% BACLOFEN
3.00% LIDOCAINE
20.00% CELECOXIB
16.00% METHYLCELLULOSE
15.00% INACTIVEDOXEPIN HCL
15.00% DOXEPIN HCL
2-week Call Pain on: 08/04/2021 by: Michal Mozes
Have you started using the medication that we sent you? (Y/N) Yes
Have you explained to the patient how to measure the dose of the medication? yes
How many times per day are you using the medication? (1-6) 2
(If more than 4 times per day, refer to a pharmacist)
How many grams of cream are you using per application? does not measure
After using this compound cream, on a scale of 1-10 (with 10 being most severe), how would 2
you assess your pain level now?
Prior to using the medication, how does the patient rate the pain on a scale from (1-10) 4
After using the compound, would you describe your pain as 'under control' Yes

225071-1_BU3 5.00% GLYCERIN

Filled: 07/23/2021 5.00% MENTHOL USP
Drug: Comp.p#6082.1 5.00% DIMETHYL SULFOXIDE
Strength: 60GM 5.00% CAMPHOR USP
Notes: Apply To Affected Area 1 Gram Twice A Day Maximum 2 Grams 5.00% MENTHOL (L), USP (CRYSTALS)
Per Day 35.00% METHYLCELLULOSE
25.00% PROPYLENE GLYCOL
20.00% CELECOXIB
2-week Call Pain on: 08/04/2021 by: Michal Mozes
Have you started using the medication that we sent you? (Y/N) Yes
Have you explained to the patient how to measure the dose of the medication? Yes
How many times per day are you using the medication? (1-6) 2
(If more than 4 times per day, refer to a pharmacist)
How many grams of cream are you using per application? does not measure
After using this compound cream, on a scale of 1-10 (with 10 being most severe), how would 2
you assess your pain level now?
Prior to using the medication, how does the patient rate the pain on a scale from (1-10) 4
After using the compound, would you describe your pain as 'under control' Yes

Printed On: 8/6/2021 At: 11:03:17AM Page: 1