New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/29/2024 12:54:00 PM
Cost:
60
Service:
Frame+lenses Ar
prescribed by doctor:
Notes:
SPH
CYL
AX
ADD
OD
3
0.75
175
OS
3
0.75
50
Date of visit:
6/17/2026 4:18:00 PM
Cost:
25
Service:
change lenses
prescribed by doctor:
Old RX
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
3
0.75
170
OS
3
0.75
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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