New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
9/13/2024 2:19:00 PM
Cost:
105
Service:
Change Lenses 2 Pairs
prescribed by doctor:
Notes:
PLANO ANTIBLUE
SPH
CYL
AX
ADD
OD
OS
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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