New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/27/2024 3:04:00 PM
Cost:
0
Service:
Change lenses
prescribed by doctor:
Old Rx
Notes:
Pro Lenses
SPH
CYL
AX
ADD
OD
3.5
-1.75
90
OS
2.5
-0.5
95
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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