New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/30/2025 3:47:00 PM
Cost:
25
Service:
Contact Lenses
prescribed by doctor:
Dr.
Notes:
Silky Gold Bella with Degrees
SPH
CYL
AX
ADD
OD
-2
-0.75
150
OS
-2
-0.75
32
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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