New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/16/2025 2:55:00 PM
Cost:
130
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
raybun, lenses pro ortive X
SPH
CYL
AX
ADD
OD
-4.5
-0.25
170
OS
-5
-0.5
20
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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