New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/4/2025 2:03:00 PM
Cost:
60
Service:
Frame + Lenses
prescribed by doctor:
Nancy
Notes:
Metallic frame+AR
SPH
CYL
AX
ADD
OD
-1
-0.5
100
OS
-1
-0.5
60
Date of visit:
5/7/2025 4:54:00 PM
Cost:
25
Service:
Contact Lenses
prescribed by doctor:
OLD Rx
Notes:
Saad Polyview Toric Lenses
SPH
CYL
AX
ADD
OD
-1
-0.5
100
OS
-1
-0.5
60
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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