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Make Rx Changes Below IMPORTANT: Refer to “Venue Rx Range” Guide for exact availability – then select from the options below. DATE MATERIAL STYLE Customer Name Contact Person Single Vision Clear Poly Account Number Aspheric Single Vision LifeRx Poly Account Phone Number Bifocal D28 SunRx Poly Aspheric Bifocal SunRx Plastic Bifocal D35 Coppertone Poly Bifocal RD24 Clear Thindex 1.70 Trifocal 7x28 Clear Plastic Patient Name uncut 1 LENS INFO I will be tinting this RX.

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