New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/18/2024 3:35:00 PM
Cost:
50
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
Metal Frame + AR Lenses
SPH
CYL
AX
ADD
OD
0
-0.25
180
OS
0
0.5
90
Date of visit:
3/19/2024 3:20:00 PM
Cost:
5
Service:
change lenses
prescribed by doctor:
Aya
Notes:
we changed OS only , left OD the same. was not comfortable in old RX
SPH
CYL
AX
ADD
OD
0
-0.25
180
OS
0.5
-1.5
180
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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