New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/1/2023 6:35:00 PM
Cost:
8
Service:
Polyview CL
prescribed by doctor:
Old Rx
Notes:
Contact Lenses
SPH
CYL
AX
ADD
OD
-1.75
OS
-1.5
Date of visit:
5/11/2024 6:37:00 PM
Cost:
11
Service:
Clear 55
prescribed by doctor:
Old Rx
Notes:
Contact lenses
SPH
CYL
AX
ADD
OD
-1.75
OS
-1.5
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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