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Prescription History

Eye Care Optical

Registered Optical Clinic

Optometrist: In-charge

Date Issued
--/--/----
Patient Name --
Age / Gender --
Mobile --
Rx Status Active

Refractive Correction

Eye Type SPH (Spherical) CYL (Cylinder) AXIS V/A (Acuity)
OD (Right) DIST 0.00 0.00 -- 6/6
OS (Left) DIST 0.00 0.00 -- 6/6

Lens & Frame Recommendations

Vision Type
Single Vision
Lens Material / Coating
Standard
Frame Recommendation
Full Rim
Recommended Next Eye Checkup

Due on: --/--/----

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