New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/27/2025 12:23:00 PM
Cost:
11
Service:
Contact Lenses
prescribed by doctor:
Px Herself
Notes:
Clear 55
SPH
CYL
AX
ADD
OD
-3
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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