           EMMAUS- SWISS EYE SERVICE
                             KUPPAM / PALAMANER, Chittoor Dist.
                                                                 Age 52 Sex M

     Hospital No 2223/36719.

    Name_
                                                                        15 30 45 60


                               R.

  15 30 45 60



                                                                                              75                105 120 135 150 165 180
                                                                                                    90

                                                                                                                             AXIS
                        75 90                105 120 135 150 165 180                                      CYL
                                                                                        SPH
                                                                       AXIS                                                                     ·/·
                                                        CYL
                                       SPH
                                                                                      41.00

                                    1050
   DISTANCE


  MID DIST                                                                             +3.25

                               +2.75
 NEAR
                                                                                                                   .. Base
                                                                                . Add Prism
                                                Base
                Add

                                                                                                             below centre
1. Distance between Optical Centres : Distance 67 m-m Near 65 m-m
                                                                                                                                          m-m
                                       m-m Central m-m Above Centre
                                                                                                   m-m IN
2. Height of bridge
                                                                 OUT                                                                      m-m
                                                                                                                    Tep
 3. Bridge bent FLUSH
                                                                                                                     m-m

                                                                                                                                          m-m
                                                                                                                    Base

     4. Curve of bridge _m-m width between centre of pads                                                                             m-m

                                                                       m-m Hockey sides to bend


        5. Curi Side fill length




        PANTOSCOPIC or ROUND
                                                              KDE9,


      Remarks
                                                                                                         DR. OLGA DAVID M. B.B. $. D.O .,

                                                                                                          EYE SURGEON

    Date : 6/3/23                                                                                         EMMAU Signature FVE SERVICE



  NB. :. Please bring this with you on future visit

{'clinic_pharmacy_details': {'clinic_pharmacy_name': 'EMMAUS- SWISS EYE SERVICE', 'clinic_pharmacy_address': 'KUPPAM / PALAMANER, Chittoor Dist.', 'clinic_pharmacy_city': 'NA', 'clinic_pharmacy_pincode': 'NA'}, 'doctor_details': {'doctor_name': 'DR. OLGA DAVID M. B.B. $. D.O .', 'doctor_qualifications': 'EYE SURGEON', 'doctor_registration_number': 'NA'}, 'patient_details': {'patient_name': 'Name_'}, 'prescription_details': {'date_of_doctor_consultation': '6/3/23'}, 'procedure': {'chief_complaints_diagnosis': 'Chief complaints and diagnosis not provided'}, 'medicine_details': [], 'lab_test_details': {'lab_test_names': 'Lab tests not requested', 'procedure_request': 'Procedure request not provided'}}