New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/4/2025 10:55:00 AM
Cost:
10
Service:
old frame
prescribed by doctor:
Old RX
Notes:
change one lens 1 lens AR
SPH
CYL
AX
ADD
OD
OS
-0.75
-1.5
35
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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