New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/27/2025 4:06:00 PM
Cost:
20
Service:
Change Lenses ONLY
prescribed by doctor:
Old RX
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
1
0.75
160
OS
0.5
0.5
100
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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