New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/15/2025 11:01:00 AM
Cost:
115
Service:
Change Lenses
prescribed by doctor:
Dr. Asaad Sharafldeen
Notes:
freeform progressive lenses
SPH
CYL
AX
ADD
OD
3.25
2.5
OS
3
2.5
Date of visit:
1/15/2025 11:04:00 AM
Cost:
40
Service:
change lenses
prescribed by doctor:
Old RX
Notes:
soler idol
SPH
CYL
AX
ADD
OD
3.25
OS
3
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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