New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/17/2026 3:37:00 PM
Cost:
100
Service:
Frame + Lenses+change lenses
prescribed by doctor:
luna
Notes:
AR FOR 3 (2 Change lenses+1 frame +lenses)
SPH
CYL
AX
ADD
OD
2
2.25
OS
0.25
2.25
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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