Prescription Copy Generator

Club Compound | GLP-1 Therapy Services | Patient Copy

Select a prescriber from the dropdown to auto-populate the NPI, or choose “Enter Prescriber Manually” if not listed.

Prescriber Name *

NPI Number *

Search Patient (IntakeQ)

Patient Name *

Date of Birth *

Patient Phone

Patient ID / MRN

Patient Address *

Medication Name *

Strength/Concentration *

Form *

Quantity *

Days Supply *

Sig (Directions) *

Program and diagnosis information are standardized for GLP-1 therapy prescriptions.

Program Type

Diagnosis Code (ICD-10)

Date Written *

Generated Prescription Copy Preview

✓ Prescription copy PDF has been generated and shared to IntakeQ if possible. The preview below shows the content.