New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
7/4/2024 6:41:00 PM
Cost:
15
Service:
Change Lenses
prescribed by doctor:
Luna
Notes:
For Near ONLY
SPH
CYL
AX
ADD
OD
1
-0.5
95
2.25
OS
1.25
-0.5
95
2.25
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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