New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
8/8/2024 11:17:00 AM
Cost:
30
Service:
Metel Frame +Transtion Ar
prescribed by doctor:
OLD RX
Notes:
SPH
CYL
AX
ADD
OD
-1.75
-0.5
20
OS
-1.75
-0.5
30
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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