Get IL HFS 2803 2008-2024
MI, LAST) 7. RECIPIENT NO. POWER 8. BIRTHDATE PRISM DPD NPD R L SPHERE CYLINDER AXIS IN OUT UP DOWN SEGMENT O.C. HEIGHT ADDITIONAL INFORMATION R L ADD HEIGHT BASE CURVE DEC INSET LENS MATERIAL TOTAL check one: R Glass L LENS STYLE Plastic Polycarbonate FRAME MATERIAL (CHECK ONE): PLASTIC FRAME NAME MFG. METAL FRONT/CHASSIS COLOR EYE DBL TPL SIZE My signature certifies that all entries on this document are true, accurate and complete; records necessary to fully di.
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