New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
11/3/2025 4:50:00 PM
Cost:
30
Service:
Contact Lenses
prescribed by doctor:
Notes:
POLYVIEW BOX 3 PAIRS
SPH
CYL
AX
ADD
OD
7
OS
7
Date of visit:
1/1/2026 3:29:00 PM
Cost:
30
Service:
Contact Lenses
prescribed by doctor:
OLD Rx
Notes:
poly view +solution
SPH
CYL
AX
ADD
OD
7
OS
7
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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