New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/27/2025 6:36:00 PM
Cost:
130
Service:
Frame + Lenses
prescribed by doctor:
Luna
Notes:
Tomford + AR + TRANS W9
SPH
CYL
AX
ADD
OD
0.5
-0.25
18
OS
1.25
-0.75
150
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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