New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
10/22/2025 1:39:00 PM
Cost:
110
Service:
Frame (2)+ Lenses( 2)
prescribed by doctor:
Notes:
AR Lenses , the places that are not filled because of there abscence on file
SPH
CYL
AX
ADD
OD
1.75
-1.25
80
2.75
OS
1.5
-0.75
90
2.75
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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