New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
9/6/2024 1:31:00 PM
Cost:
68
Service:
Frame + Lenses + Contact Lenses
prescribed by doctor:
Old RX
Notes:
Anti Blue + PolyView (-2.25)
SPH
CYL
AX
ADD
OD
-1.25
-1
180
OS
-1.75
-0.75
10
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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