New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/17/2025 2:26:00 PM
Cost:
145
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
New Frame + Old Frame (2 pairs of lenses) 1.61
SPH
CYL
AX
ADD
OD
-1.5
-4.75
11
OS
-0.5
-4.75
177
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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