New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/23/2025 10:51:00 AM
Cost:
130
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
2 frames , AR Lenses for both for near 1.67
SPH
CYL
AX
ADD
OD
2
-0.5
110
2.5
OS
3.25
-0.5
85
2.5
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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