New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
7/18/2025 11:55:00 AM
Cost:
25
Service:
Change Lenses
prescribed by doctor:
oldrx
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
-2
OS
-2
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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