New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
8/11/2025 10:41:00 AM
Cost:
30
Service:
Contact Lenses
prescribed by doctor:
old rx
Notes:
toric
SPH
CYL
AX
ADD
OD
2.5
-3
175
OS
2.75
-3
170
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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