New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/19/2024 11:51:00 AM
Cost:
55
Service:
Frame + Lenses
prescribed by doctor:
Aya
Notes:
Airlite + Anti-blue Lenses
SPH
CYL
AX
ADD
OD
-2.75
-1
180
OS
-2.25
-1
160
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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