New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/25/2025 2:18:00 PM
Cost:
100
Service:
CHANGE Lenses
prescribed by doctor:
Nancy
Notes:
Old Frame + NEW AR 1.61 LENSES
SPH
CYL
AX
ADD
OD
5
2
80
OS
5.5
1.5
90
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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