New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/19/2024 5:04:00 PM
Cost:
15
Service:
Change lenses AR
prescribed by doctor:
Aya
Notes:
For Near ONLY
SPH
CYL
AX
ADD
OD
-0.25
-0.5
106
2.5
OS
-0.25
-0.75
5
2.5
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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