New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/4/2024 6:29:00 PM
Cost:
110
Service:
Frame + Lenses
prescribed by doctor:
Aya
Notes:
Tom Ford Frame + Transition + AR
SPH
CYL
AX
ADD
OD
0.75
-1.5
20
OS
1.5
-3.25
160
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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