New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
11/25/2025 12:40:00 PM
Cost:
35
Service:
Change Lenses
prescribed by doctor:
OLD Rx
Notes:
AntiBlue Lenses (PLANO FOR OU)
SPH
CYL
AX
ADD
OD
0
OS
0
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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