New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/25/2025 3:28:00 PM
Cost:
30
Service:
Change Lenses ONLY
prescribed by doctor:
Luna
Notes:
1.61 Lenses AR
SPH
CYL
AX
ADD
OD
4
-0.5
160
OS
4.25
-0.5
165
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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