New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/24/2025 12:23:00 PM
Cost:
235
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
Progressive infinity +AR+ Montage
SPH
CYL
AX
ADD
OD
1.5
1
175
2.5
OS
1
0.75
175
2.5
Date of visit:
4/24/2025 1:03:00 PM
Cost:
0
Service:
change lenses
prescribed by doctor:
Old RX
Notes:
Change lenses For distance on old glasses
SPH
CYL
AX
ADD
OD
1.5
1
175
OS
1
0.75
175
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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