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Certified Paraoptometric Technician Review Course CPOT - Idaho ...

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Ordering formInclude thefollowinginformationCONTACT LENS ORDER FORMPatient Name: John DoeSpecifications Ordered Specifications VerifiedDate 2/23/01 DateO.D. O.S. O.D. O.S.B.C.R 7.89 7.81 B.C.RS.C.R./W 8.90 /.3 8.80 /.3 S.C.R./WI.C.R./W I.C.R./WP.C.R./W 110.9 /.3 10.8 /.3 P.C.R./WO.Z.D. 8.0 8.0 O.Z.D.Dia 9.2 9.2 DiaPower - 2.50 - 2.50 PowerC.T. .16 .16 C.T.Blend Med Med BlendTint Blue Blue TintDot O.D. Verified byAdditional InformationAccepted Rejected Returned for Credit Date ReturnedReason for return/reorder

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