New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/14/2026 2:41:00 PM
Cost:
60
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
Antiblue
SPH
CYL
AX
ADD
OD
0
-0.25
167
OS
0
-0.25
10
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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