New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/22/2025 12:09:00 PM
Cost:
100
Service:
Frame + Lenses
prescribed by doctor:
old Rx
Notes:
Metal Frame + AR Transition 1.61 for OS
SPH
CYL
AX
ADD
OD
0
OS
-0.75
-3
60
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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