New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/22/2025 11:55:00 AM
Cost:
0
Service:
2Frame + 2Lenses
prescribed by doctor:
Old RX
Notes:
One For Distance and One for Near ARlenses
SPH
CYL
AX
ADD
OD
0
-2.5
40
2
OS
0
-2.75
160
2
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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