New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/21/2025 11:37:00 AM
Cost:
120
Service:
Frame + Lenses
prescribed by doctor:
old rx
Notes:
Antiblue modern 1.67
SPH
CYL
AX
ADD
OD
-5
-0.5
25
OS
-5
-0.25
165
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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