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Daily Stock Lens Order Form
Daily stock lens order
Store name or Acc No:
Patient Name or Tray #
Qty. (piece)
Material
SPH
CYL
Add
OD
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Job #1
CR39UC 65mm
CR39UC 70mm
CR39UC 60mm
CR39HC
CR39AR
1.56HC
1.56AR
1.60HC
1.60AR
1.67HC
1.67AR
1.74AR
FT28 UC
CR39ProgUC
PolyHC
PolyAR
PolyPhotochromicGrayHC
PolyPhotochromicGrayAR
1.56PhotochromicGray
1.56PhotochromicBrown
OS
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Qty. (piece)
Patient Name or Tray #
Material
SPH
CYL
Add
OD
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Job #2
CR39UC 65mm
CR39UC 70mm
CR39UC 60mm
CR39HC
CR39AR
1.56HC
1.56AR
1.60HC
1.60AR
1.67HC
1.67AR
1.74AR
FT28 UC
CR39ProgUC
PolyHC
PolyAR
PolyPhotochromicGrayHC
PolyPhotochromicGrayAR
1.56PhotochromicGray
1.56PhotochromicBrown
OS
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Qty. (piece)
Patient Name or Tray #
Material
SPH
CYL
Add
OD
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Job #3
CR39UC 65mm
CR39UC 70mm
CR39UC 60mm
CR39HC
CR39AR
1.56HC
1.56AR
1.60HC
1.60AR
1.67HC
1.67AR
1.74AR
FT28 UC
CR39ProgUC
PolyHC
PolyAR
PolyPhotochromicGrayHC
PolyPhotochromicGrayAR
1.56PhotochromicGray
1.56PhotochromicBrown
OS
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Patient Name or Tray #
Qty. (piece)
Material
SPH
CYL
Add
OD
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Job #4
CR39UC 65mm
CR39UC 70mm
CR39UC 60mm
CR39HC
CR39AR
1.56HC
1.56AR
1.60HC
1.60AR
1.67HC
1.67AR
1.74AR
FT28 UC
CR39ProgUC
PolyHC
PolyAR
PolyPhotochromicGrayHC
PolyPhotochromicGrayAR
1.56PhotochromicGray
1.56PhotochromicBrown
OS
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Patient Name or Tray #
Qty. (piece)
Material
SPH
CYL
Add
OD
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Job #5
CR39UC 65mm
CR39UC 70mm
CR39UC 60mm
CR39HC
CR39AR
1.56HC
1.56AR
1.60HC
1.60AR
1.67HC
1.67AR
1.74AR
FT28 UC
CR39ProgUC
PolyHC
PolyAR
PolyPhotochromicGrayHC
PolyPhotochromicGrayAR
1.56PhotochromicGray
1.56PhotochromicBrown
OS
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Patient Name or Tray #
Material
Qty. (piece)
SPH
CYL
Add
OD
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Job #6
CR39UC 65mm
CR39UC 70mm
CR39UC 60mm
CR39HC
CR39AR
1.56HC
1.56AR
1.60HC
1.60AR
1.67HC
1.67AR
1.74AR
FT28 UC
CR39ProgUC
PolyHC
PolyAR
PolyPhotochromicGrayHC
PolyPhotochromicGrayAR
1.56PhotochromicGray
1.56PhotochromicBrown
OS
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Patient Name or Tray #
Material
Qty. (piece)
SPH
CYL
Add
OD
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Job #7
CR39UC 65mm
CR39UC 70mm
CR39UC 60mm
CR39HC
CR39AR
1.56HC
1.56AR
1.60HC
1.60AR
1.67HC
1.67AR
1.74AR
FT28 UC
CR39ProgUC
PolyHC
PolyAR
PolyPhotochromicGrayHC
PolyPhotochromicGrayAR
1.56PhotochromicGray
1.56PhotochromicBrown
OS
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Patient Name or Tray #
Qty. (piece)
Material
SPH
CYL
Add
OD
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Job #8
CR39UC 65mm
CR39UC 70mm
CR39UC 60mm
CR39HC
CR39AR
1.56HC
1.56AR
1.60HC
1.60AR
1.67HC
1.67AR
1.74AR
FT28 UC
CR39ProgUC
PolyHC
PolyAR
PolyPhotochromicGrayHC
PolyPhotochromicGrayAR
1.56PhotochromicGray
1.56PhotochromicBrown
OS
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Patient Name or Tray #
Qty. (piece)
Material
SPH
CYL
Add
OD
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Job #9
CR39UC 65mm
CR39UC 70mm
CR39UC 60mm
CR39HC
CR39AR
1.56HC
1.56AR
1.60HC
1.60AR
1.67HC
1.67AR
1.74AR
FT28 UC
CR39ProgUC
PolyHC
PolyAR
PolyPhotochromicGrayHC
PolyPhotochromicGrayAR
1.56PhotochromicGray
1.56PhotochromicBrown
OS
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Patient Name or Tray #
Qty. (piece)
Material
SPH
CYL
Add
OD
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Job #10
CR39UC 65mm
CR39UC 70mm
CR39UC 60mm
CR39HC
CR39AR
1.56HC
1.56AR
1.60HC
1.60AR
1.67HC
1.67AR
1.74AR
FT28 UC
CR39ProgUC
PolyHC
PolyAR
PolyPhotochromicGrayHC
PolyPhotochromicGrayAR
1.56PhotochromicGray
1.56PhotochromicBrown
OS
+0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
-5.50
-5.75
-6.00
-6.25
-6.50
-6.75
-7.00
-7.25
-7.50
-7.75
-8.00
-8.25
-8.50
-8.75
-9.00
-9.25
-9.50
-9.75
-10.00
-10.50
-11.00
-11.50
-12.00
-12.50
-13.00
-13.50
-14.00
+0.25
+0.50
+0.75
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
+3.25
+3.50
+3.75
+4.00
+4.25
+4.50
+4.75
+5.00
+5.25
+5.50
+5.75
+6.00
-0.00
-0.25
-0.50
-0.75
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
-4.00
+1.00
+1.25
+1.50
+1.75
+2.00
+2.25
+2.50
+2.75
+3.00
Special
Instruction
Built with Simfatic Forms
order form builder
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