New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/30/2025 12:44:00 PM
Cost:
0
Service:
2 Frames + 2 Pairs of Lenses
prescribed by doctor:
Dr. In Holland
Notes:
AR for Both 1.61
SPH
CYL
AX
ADD
OD
-3.5
OS
-2
-1.75
170
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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