New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/26/2025 11:31:00 AM
Cost:
Service:
refraction
prescribed by doctor:
Nancy
Notes:
AR
SPH
CYL
AX
ADD
OD
-1.25
-0.5
175
OS
-1.25
-0.5
178
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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