New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/14/2025 12:04:00 PM
Cost:
60
Service:
AR
prescribed by doctor:
Old RX
Notes:
MARCON FRAME + AR
SPH
CYL
AX
ADD
OD
1.25
1.25
12
OS
2
0.5
160
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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