New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/26/2024 2:56:00 PM
Cost:
15
Service:
Change Lenses
prescribed by doctor:
Aya
Notes:
reading only
SPH
CYL
AX
ADD
OD
2
OS
2
Date of visit:
12/24/2024 1:42:00 PM
Cost:
20
Service:
Change lenses
prescribed by doctor:
Old Rx
Notes:
For Near
SPH
CYL
AX
ADD
OD
2
OS
2
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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