New Rx Order

Account Name: Date: 30-Jun-2022 04:17 PM
Account Number: Address:
PRESCRIPTION
Patient/Reference *
  Reader Prescription
 (Please check this box if this is patient's Reader Prescription)
 DISTANCE
 
R
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L
Sphere*
Cylinder
Axis
 READING
 
R
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L
Add
Seg/OC Height(mm)
Distance PD(mm)
*
Near PD(mm)
JOB / FRAME INFORMATION
Job Type