New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/10/2025 11:12:00 AM
Cost:
35
Service:
Frame + Lenses
prescribed by doctor:
Dr. Carole Cherfan
Notes:
AR for far
SPH
CYL
AX
ADD
OD
0.5
3.5
170
3
OS
1.5
2
180
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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