New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/11/2025 5:25:00 PM
Cost:
30
Service:
1 Box of contact lenses
prescribed by doctor:
Notes:
Polyview BOX
SPH
CYL
AX
ADD
OD
7
OS
7
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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