New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/2/2025 1:25:00 PM
Cost:
15
Service:
Contact Lenses
prescribed by doctor:
OLD RX
Notes:
PolyView + Clear View (Hyperopic)
SPH
CYL
AX
ADD
OD
2.5
OS
1
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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