New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/26/2025 10:30:00 AM
Cost:
20
Service:
change lenses
prescribed by doctor:
Old RX
Notes:
AR
SPH
CYL
AX
ADD
OD
2
OS
2.25
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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