New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/3/2024 6:53:00 PM
Cost:
30
Service:
Biofinity Contact Lenses
prescribed by doctor:
Old Rx
Notes:
SPH
CYL
AX
ADD
OD
-1.25
-0.75
130
OS
-0.75
-0.75
30
Date of visit:
5/4/2024 6:54:00 PM
Cost:
25
Service:
Bella Jade Green With Degrees
prescribed by doctor:
Old Rx
Notes:
Spherical Equivalence
SPH
CYL
AX
ADD
OD
-1.5
OS
-1.25
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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