New Rx Order

Account Name: Date: 29-Mar-2024 08:08 AM
Account Number: Address:
PRESCRIPTION
Patient/Reference *
 Readers Prescription
   (Check this box if this order is patient's Readers Prescription)
 DISTANCE
 
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Cylinder
Axis
 READING
 
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Seg/OC Height(mm)
Distance PD(mm)
*
Near PD(mm)
JOB / FRAME INFORMATION
Job Type