New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/1/2025 3:09:00 PM
Cost:
120
Service:
2 Frames + 2 Lenses
prescribed by doctor:
Nancy
Notes:
1 for Dist 1 for Near
SPH
CYL
AX
ADD
OD
2.25
-0.5
105
1
OS
2.5
-1.25
90
1
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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