|
|
|
|
Glasses RX
|
OD
|
|
SPH
|
CYL
|
|
AXIS
|
ADD
|
|
PRISM
|
|
|
SPH
|
CYL
|
|
AXIS
|
ADD
|
|
PRISM
|
|
|
OS
|
|
|
SPH
|
CYL
|
|
AXIS
|
ADD
|
|
PRISM
|
|
|
SPH
|
CYL
|
|
AXIS
|
ADD
|
|
PRISM
|
|
|
Distance PD
|
Near PD
|
|
Expiration Date
|
|
|
Contact Lens RX
|
OD
|
|
POWER
|
BC
|
|
DIA
|
CONTACT LENS NAME
|
|
POWER
|
BC
|
|
DIA
|
CONTACT LENS NAME
|
|
OS
|
|
|
POWER
|
BC
|
|
DIA
|
CONTACT LENS NAME
|
|
POWER
|
BC
|
|
DIA
|
CONTACT LENS NAME
|
|
|
|
|
Contact Lens Expiration Date
|
|
|
CL SOLUTIONS
|
CL Replacement Schedule
|
|
Duration
|
CL Follow-Up Needed
|
|
Duration
|
Recommendation
|
