New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/29/2025 1:28:00 PM
Cost:
100
Service:
2 Frames + 2 Pairs of Lenses
prescribed by doctor:
Luna
Notes:
1 Dist and 1 for Near 60mm (50$ each)
SPH
CYL
AX
ADD
OD
2
2.25
OS
2
-0.5
97
2.25
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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