New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
10/22/2025 12:13:00 PM
Cost:
160
Service:
2 Frames + 2 Pairs of Lenses
prescribed by doctor:
Nancy
Notes:
Harley Davidson for Dist( Trans+W9) and another for near AR
SPH
CYL
AX
ADD
OD
-0.25
-1.75
173
1.5
OS
-0.5
-0.75
5
1.5
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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