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---
type: prescription
category: eye
person: Xuewei Jiang
date: 2021-11-17
provider: Maylin Gonzalez, OD — Eyed LA Optometry
source: jiang_LA_2021.pdf
---
# Eyeglass Rx — Xuewei Jiang — 11/17/2021
## Provider
- **Practice:** Eyed LA Optometry
- **Doctor:** Maylin Gonzalez, OD
- **License #:** 14297
- **Address:** 1150 18th Street suite 103, Santa Monica CA 90403
- **Phone:** (424) 208-3107
## Patient Information
- **Patient:** Xuewei Jiang
- **DOB:** 03/13/1993
- **Address:** 11950 Idaho Ave. apt. 113, Los Angeles CA 90025
## Exam Details
- **Date:** 11/17/2021
- **Expires:** 11/17/2023
- **Rx #:** 168263508
## Rx Details
| | Sphere | Cyl | Axis | Near Add | Int Add | H Prism | V Prism |
|----|--------|-------|------|----------|---------|---------|---------|
| OD | -3.25 | | | | | | |
| OS | -3.25 | -0.25 | 098 | | | | |
- **Distance PD:** 58.0
## Special Instructions and Recommendations
| Feature | Value |
|----------------|---------------|
| Material | Polycarbonate |
| Tint | |
| AR Coating | Yes |
| Photochromic | |
| UV Treatment | Yes |
| Polarized | |
| LensType | |
| Instructions | |
Signed: Maylin Gonzalez, OD

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---
type: prescription
category: eye
person: Xuewei Jiang
date: 2024-12-30
provider: Domenico M. Rinaldi, O.D. — Marina Del Rey Optometry
source: jiang_eye_exam_12-2024.pdf
---
# Eye Exam Prescription — Xuewei Jiang — 12/30/2024
## Provider
- **Practice:** Marina Del Rey Optometry
- **Address:** 4266 Lincoln Blvd., Marina Del Rey, CA 902925618
- **Phone:** (310) 823-4595
- **Fax:** (310) 823-4598
- **Website:** www.marinadelreyoptometry.com
- **Doctor:** Domenico M. Rinaldi, O.D.
- **LIC#:** 34194 TLG
## Patient Information
- **Patient Name:** Xuewei Jiang
- **Address:** 12421 Sanford St, Los Angeles, CA 90066
- **Date of Birth:** 03/13/1993
## Exam Details
- **Exam Date:** 12/30/2024
- **Print Date:** 12/30/2024
- **Expires:** 12/30/2026
- **Type:** Final Rx
- **Use:** Continual
## Prescription
| | Sphere | Cyl | Axis | Prism | PD |
|-------|--------|-----|------|-------|----|
| OD | -3.25 | | | | |
| OS | -3.50 | | | | |
| ADD | |
|-----|-----|
| OD | |
| OS | |
## Recommendations
- Single Vision
- Crizal Rock (non glare)
- Polycarbonate

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---
type: prescription
category: eye
person: Xuewei Jiang
date: 2025-12-29
provider: Domenico M. Rinaldi, O.D. — Marina Del Rey Optometry
source: jiang_eye_exam_12-2025.HEIC
---
# Eye Exam Prescription — Xuewei Jiang — 12/29/2025
## Provider
- **Practice:** Marina Del Rey Optometry
- **Address:** 4266 Lincoln Blvd., Marina Del Rey, CA 902925618
- **Phone:** (310) 823-4595
- **Fax:** (310) 823-4598
- **Website:** www.marinadelreyoptometry.com
- **Doctor:** Domenico M. Rinaldi, O.D.
- **LIC#:** 34194 TLG
## Patient Information
- **Patient Name:** Xuewei Jiang
- **Address:** 12421 Sanford St, Los Angeles, CA 90066
- **Date of Birth:** 03/13/1993
## Exam Details
- **Exam Date:** 12/29/2025
- **Print Date:** 12/29/2025
- **Expires:** 12/29/2027
- **Type:** Final Rx
- **Use:** Continual
## Prescription
| | Sphere | Cyl | Axis | Prism | PD |
|-------|--------|-----|------|-------|----|
| OD | -3.25 | | | | |
| OS | -3.50 | | | | |
| ADD | |
|-----|-----|
| OD | |
| OS | |
## Recommendations
- Single Vision
- Crizal Rock (non glare)
- Polycarbonate

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---
type: receipt
category: eye
person: Xuewei Jiang
date: 2025-12-29
provider: Del Rey Optometry
source: jiang_eye_exam_receipt2_12-2025.HEIC
---
# Credit Card Receipt — Xuewei Jiang — 12/29/2025
## Store Information
- **Store:** T010 Del Rey Optometry
- **Address:** 4266 Lincoln Boulevard, Marina del Rey, CA 90292
- **Phone:** (310) 823-4595
- **Date/Time:** 2025-12-29 10:09 AM
## Transaction Details
| Field | Value |
|-------|-------|
| Account # | ************7357 |
| Card Brand | VISA |
| Type | SALE |
| Entry | SWIPE |
| Approval code | 603071 |
| MID | MUtka9mjqXbXZbGHJQpbTCXv |
| TID | TRjfWamaJ2wgk8RgDCzzxMkV |
| DID | DV6MauJjs1BEXPzmaPoZYDa |
## Result
**SUCCEEDED**
ARQC
## Amount
| | |
|---|---|
| AMOUNT | $30.00 |
| =TOTAL | $30.00 |
> I agree to pay the above total amount according to the card issuer agreement
*Thank You — Cardholder Copy*

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---
type: receipt
category: eye
person: Xuewei Jiang
date: 2025-12-29
provider: Del Rey Optometry Marina Del Rey
source: jiang_eye_exam_receipt_12-2025.HEIC
---
# Eye Exam Receipt — Xuewei Jiang — 12/29/2025
## Store Information
- **Store:** Del Rey Optometry Marina Del Rey 10
- **Address:** 4266 Lincoln Blvd., Marina Del Rey, CA 90252-5618, United States
- **Phone:** 310-823-4595
## Receipt Details
- **Receipt #:** 3010062
- **Date:** 12/29/25 @ 10:10 AM
- **Store:** 29010 | Register: 3
- **Cashier:** Paola 330031
- **Salesperson:** 330031 (Paola)
- **Order For:** Xuewei (Erica) Jiang
- **Sales Order:** 10122841429010
## Line Items
| Item | Qty | Price | Amount |
|------|-----|-------|--------|
| 92015 Refraction (20500001669638) | 1 | 59.00 | 17.90 |
| 4321-INSURANCE DISCOUNT | | | (41.10) |
| Sales Order 10122841429010 [Doctor Service Addon] | | | |
| Optomap (20500001865028) | 1 | 29.00 | 20.00 |
| 4321-INSURANCE DISCOUNT | | | (19.00) |
| Sales Order 10122841429010 [Doctor Service Addon] | | | |
| 92014 Est Comprehensive (20500001982051) | 1 | 159.00 | 71.60 |
| 4321-INSURANCE DISCOUNT | | | (87.40) |
| Sales Order 10122841429010 [Doctor Service] | | | |
| ADD-ON ONLY PACKAGE ARTICLE | | | |
## Totals
| | Amount |
|---|--------|
| Subtotal | 109.50 |
| Tax | 0.00 |
| **Total** | **109.50** |
## Payment
| | Amount |
|---|--------|
| Assignment Vision Care (10122841429010) | 79.50 |
| Visa 7257 | 30.00 |
| Auth #: | |
| Transaction Type: Sale | |
| Entry Method: Keyed | |
| Auth Time: 10:10 AM | |
| **Change** | **0.00** |
## Notes
> Guarantee: Our goal is 100% satisfaction! If you're not completely satisfied with your purchase within the first 30 days, just let us know. We're committed to making it right.
Total Item(s) purchased: 3
*Customer Copy*

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---
type: eye exam record
category: eye
person: Yanxin Lu
date: 2017-09-14
provider: Dr. Catherine Park, O.D.
source: lu_Austin_2017.pdf
---
# Eye Exam Record — Yanxin Lu — 09/14/2017
**Patient:** Lu, Yanxin
**DOB:** 10/17/1989
**Electronically signed by:** Dr. Park, Catherine — 09/14/2017
**Electronic Signature:** Electronically Signed By: Catherine Park O.D. on 09/17/2017 09:05 AM
---
## Page 1 of 4
### Current Glasses Rx
| | Sphere | Cyl | Axis |
|----------|--------|-------|------|
| OD | -5.50 | -0.75 | 047 |
| OS | -5.25 | -1.00 | 138 |
| Visual Acuity | OD | OS | OU |
|---------------|-------|-------|-------|
| DVA | 20/25 | 20/25 | 20/20 |
| NVA | | | 20/20 |
### Current Glasses Rx2
- DVA:
- NVA:
### Auto Refraction
| | Sphere | Cyl | Axis |
|----------|--------|-------|------|
| OD | -5.75 | -1.50 | 031 |
| OS | -5.50 | -2.00 | 139 |
- DVA:
- NVA:
### Manifest Refraction
| | Sphere | Cyl | Axis |
|----------|--------|-------|------|
| OD | -5.50 | -1.25 | 030 |
| OS | -5.50 | -1.75 | 145 |
| Visual Acuity | OD | OS | OU |
|---------------|-------|-------|-------|
| DVA | 20/20 | 20/20 | 20/20 |
| NVA | 20/20 | 20/20 | 20/20 |
### CL Trial Rx
*(empty)*
### IOP
- **Date/Time:** 9/14/2017 4:25:28 PM
- **IOP OD:** 10
- **IOP OS:** 10
- **Test:** Digital
### K-Readings
| Eye | Flat | Axis | Steep | Axis |
|-----|-------|------|-------|------|
| OD | 43.00 | 028 | 44.50 | 118 |
| OS | 43.00 | 155 | 44.50 | 065 |
### Other Measurements
- **Dist IPD:** 67.0
- **Diagnosis Code:** H52.223
- **Procedure Code:** 92015
### Rx Summary Table
| Type | Notes | Brand OD | Sphere OD | Cylinder OD | Axis OD | DVA OD | NVA OD | Brand OS | Sphere OS | Cylinder OS | Axis OS | DVA OS | NVA OS |
|------|-------|----------|-----------|-------------|---------|--------|--------|----------|-----------|-------------|---------|--------|--------|
| Presenting Spec Rx | | | -5.50 | -0.75 | 047 | 20/25 | | | -5.25 | -1.00 | 138 | 20/25 | |
| Auto Refraction | | | -5.75 | -1.50 | 031 | | | | -5.50 | -2.00 | 139 | | |
| Manifest Refraction | | | -5.50 | -1.25 | 030 | 20/20 | 20/20 | | -5.50 | -1.75 | 145 | 20/20 | 20/20 |
| Final Spec Rx | Crizal AR | | -5.50 | -1.25 | 030 | 20/20 | 20/20 | | -5.50 | -1.75 | 145 | 20/20 | 20/20 |
---
### Reason for Visit
- **EXAMINATION:** Eye Examination~Glasses examination
- **Last examination:** 3-4 years ago
- **OCCUPATION:** Student — Rice University
### Chief Complaint
*(listed but no specific complaint text provided)*
---
## Page 2 of 4
### History of Present Illness (HPI)
HISTORY OF PRESENT ILLNESS: No complaints reported of physical ocular symptoms. Not experiencing routine headaches or double vision. No reports of visual floaters below.
VISION COMPLAINT: Vision may have changed. Difficulties are not problematic.
### Patient History
- **OCULAR HISTORY:** Eye Turn.
- **MEDICAL HISTORY:** No pertinent past medical history exists.
- **SYSTEMIC FAMILY HISTORY:** Family medical history is reported to be unremarkable.
- **OCULAR SURGICAL HISTORY:** No pertinent past ocular surgical history exists.
- **OCULAR FAMILY HISTORY:** Family ocular history is reported to be unremarkable.
- **SYSTEMIC MEDICATIONS:** No reported systemic medications. No known systemic medication allergies.
- **SOCIAL HISTORY:** No reported use of tobacco, alcohol or narcotics.
### Review of Systems
REVIEW OF SYSTEMS: No reported disorders or current medical treatment of: Allergy, Cardiovascular, Constitutional, Ears/nose/mouth/throat, Endocrine, Gastrointestinal, Immunologic, Integumentary/Skin, Musculoskeletal, Neurologic, Psychiatric, Respiratory (Unless noted otherwise above)
### Vision
- **PRESENTING SPECTACLE Rx OBSERVATIONS:** RX current gl SV
- **SUBJECTIVE RESPONSES OBSERVATIONS:** Trial frame confirmed clear and comfortable vision.
---
## Page 3 of 4
### Examination
- **DILATION ORDERS:** Patient denied dilation. Patient denied Optomap.
- **CONFRONTATION FIELDS OBSERVATIONS:** Fields were found to be full in all quadrants, OD. Fields were found to be full in all quadrants, OS.
- **POSTERIOR SEGMENT:** Vitreous body clear for age and fully attached. Nerve head well perfused, with good rim tissue. Healthy macula with no edema or degenerative changes. Unless otherwise noted below.
- **DISPOSITION:** Patient is pleasant and sociable.
- **ORIENTATION:** Patient is fully alert to time, place and person.
### Impressions
- **IMPRESSION/REFRACTION:** Myopia, Astigmatism
### Plan
- **PRINTED SPEC Rx:** 09/14/2017 16:52
- **SPECTACLE PLAN:** Adaptation to Rx expected. Rec AR, impact resistance lenses, UV protection.
- Current spec Rx from China. Gave full Rx today (seemed ok with the increase using trial frame). Discussed prism and dem'd in office with LL prism. Pt noticed prism helped.
---
## Page 4 of 4
### Patient Management
- **COUNSELING / EDUCATION:** Patient has been advised to return to clinic ASAP if experiencing any of the following eye symptoms: redness, pain, discharge or vision loss. Importance of dilation as well as the side effects of dilation. I have verbally discussed my clinical findings and recommendations in detail with this patient. The patient does to call or RTC for any concerns and/or questions.
- **ORDERS:** Schedule on or about: Examination: Annual Eye Examination. Timeline: 120090601.
### Diagnosis
- Myopia, bilateral — H52.13
- Regular astigmatism, bilateral — H52.223
### Procedure
- Exam Comp. New
- Current Tobacco Non-user
- Exam Refraction New Patient
### Addendum
*(empty)*

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---
type: prescription
category: eye
person: Yanxin Lu
date: 2022-07-05
provider: Bijan Cohenmehr, O.D.
source: lu_LA_2022.jpg
---
# Eye Exam Prescription — Yanxin Lu — 7/5/22
## Provider
- **Doctor:** Bijan Cohenmehr, O.D.
- **Address:** 12222 Wilshire Blvd., Suite 105, Los Angeles, CA 90025
- **Tel:** (310) 828-2010
- **Fax:** (424) 832-3712
- **Lic. #:** 10047T
## Patient Information
- **Rx for:** Lu, Yanxin
- **Date:** 7/5/22
## Prescription
| | Sphere | Cylinder | Axis | Doc | Prism | Base |
|------|--------|----------|------|-----|-------|------|
| OD (DIST) | -5.50 | -1.75 | 35 | | | |
| OS (DIST) | -5.50 | -1.25 | 148 | | | |
| ADD | |
|-----|---|
| R | |
| L | |
| Bifocal | | |
|---------|---|---|
| TYPE | SEG. SIZE | SEG. POSITION |
| | | |
## PD
| DIST | NEAR |
|------|------|
| 66 | |
## Tint
*(empty)*
## Remarks
- 2nd Pair:
- IMPACT RESISTANT, MUST MEET Z-80 STANDARDS. VOID IF ALTERED. VALID FOR 1 YEAR FROM ABOVE DATE.
## Notes
> FILLING THIS PRESCRIPTION CONSTITUTES AN AGREEMENT TO RE-MAKE LENSES AT MY DIRECTION FOR A PERIOD OF NINETY (90) DAYS WITHOUT FURTHER CHARGE TO ME OR MY PATIENT.
> -NOT FOR CONTACT LENSES.

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---
type: prescription
category: eye
person: Yanxin Lu
date: 2022-07-05
provider: Bijan Cohenmehr, O.D.
source: lu_LA_2022_modified.jpg
---
# Eye Exam Prescription — Yanxin Lu — 7/5/22
## Provider
- **Doctor:** Bijan Cohenmehr, O.D.
- **Address:** 12222 Wilshire Blvd., Suite 105, Los Angeles, CA 90025
- **Tel:** (310) 828-2010
- **Fax:** (424) 832-3712
- **Lic. #:** 10047T
## Patient Information
- **Rx for:** Lu, Yanxin
- **Date:** 7/5/22
## Prescription
| | Sphere | Cylinder | Axis | Doc | Prism | Base |
|------|--------|----------|------|-----|-------|------|
| OD (DIST) | -5.50 | -1.25 | 35 | | | |
| OS (DIST) | -5.50 | -1.25 | 148 | | | |
| ADD | |
|-----|---|
| R | |
| L | |
| Bifocal | | |
|---------|---|---|
| TYPE | SEG. SIZE | SEG. POSITION |
| | | |
## PD
| DIST | NEAR |
|------|------|
| 66 | |
## Tint
*(empty)*
## Remarks
- 2nd Pair:
- IMPACT RESISTANT, MUST MEET Z-80 STANDARDS. VOID IF ALTERED. VALID FOR 1 YEAR FROM ABOVE DATE.
## Notes
> FILLING THIS PRESCRIPTION CONSTITUTES AN AGREEMENT TO RE-MAKE LENSES AT MY DIRECTION FOR A PERIOD OF NINETY (90) DAYS WITHOUT FURTHER CHARGE TO ME OR MY PATIENT.
> -NOT FOR CONTACT LENSES.

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---
type: prescription
category: eye
person: Yanxin Lu
date: 2024-12-30
provider: Domenico M. Rinaldi, O.D. — Marina Del Rey Optometry
source: lu_eye_exam_12-2024.pdf
---
# Eye Exam Prescription — Yanxin Lu — 12/30/2024
## Provider
- **Practice:** Marina Del Rey Optometry
- **Address:** 4266 Lincoln Blvd., Marina Del Rey, CA 902925618
- **Phone:** (310) 823-4595
- **Fax:** (310) 823-4598
- **Website:** www.marinadelreyoptometry.com
- **Doctor:** Domenico M. Rinaldi, O.D.
- **LIC#:** 34194 TLG
## Patient Information
- **Patient Name:** Yanxin Lu
- **Address:** 12421 Sanford St, Los Angeles, CA 90066
- **Date of Birth:** 10/17/1989
## Exam Details
- **Exam Date:** 12/30/2024
- **Print Date:** 12/30/2024
- **Expires:** 12/30/2026
- **Type:** Final Rx
- **Use:** Continual
## Prescription
| | Sphere | Cyl | Axis | Prism | PD |
|-------|--------|-------|------|-------|----|
| OD | -5.50 | -1.25 | 31 | | |
| OS | -5.25 | -1.75 | 147 | | |
| ADD | |
|-----|-----|
| OD | |
| OS | |
## Recommendations
- Single Vision
- Crizal Rock (non glare)
- Hi Index

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---
type: prescription
category: eye
person: Yanxin Lu
date: 2025-12-29
provider: Domenico M. Rinaldi, O.D. — Marina Del Rey Optometry
source: lu_eye_exam_12-2025.HEIC
---
# Eye Exam Prescription — Yanxin Lu — 12/29/2025
## Provider
- **Practice:** Marina Del Rey Optometry
- **Address:** 4266 Lincoln Blvd., Marina Del Rey, CA 902925618
- **Phone:** (310) 823-4595
- **Fax:** (310) 823-4598
- **Website:** www.marinadelreyoptometry.com
- **Doctor:** Domenico M. Rinaldi, O.D.
- **LIC#:** 34194 TLG
## Patient Information
- **Patient Name:** Yanxin Lu
- **Address:** 12421 Sanford St, Los Angeles, CA 90066
- **Date of Birth:** 10/17/1989
## Exam Details
- **Exam Date:** 12/29/2025
- **Print Date:** 12/29/2025
- **Expires:** 12/29/2027
- **Type:** Final Rx
- **Use:** Continual
## Prescription
| | Sphere | Cyl | Axis | Prism | PD |
|-------|--------|-------|------|-------|----|
| OD | -5.25 | -1.75 | 31 | | |
| OS | -5.00 | -1.75 | 147 | | |
| ADD | |
|-----|-----|
| OD | |
| OS | |
## Recommendations
- Single Vision
- Crizal Rock (non glare)
- Hi Index

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---
type: receipt
category: eye
person: Yanxin Lu
date: 2025-12-29
provider: Del Rey Optometry
source: lu_eye_exam_receipt2_12-2025.HEIC
---
# Credit Card Receipt — Yanxin Lu — 12/29/2025
## Store Information
- **Store:** T010 Del Rey Optometry
- **Address:** 4266 Lincoln Boulevard, Marina del Rey, CA 90292
- **Phone:** (310) 823-4595
- **Date/Time:** 2025 12 29 10:08 AM
## Transaction Details
| Field | Value |
|-------|-------|
| Card Type | MASTERCARD |
| AID | A0000000041010 |
| Account # | ************4800 |
| Card Brand | MASTERCARD |
| Type | SALE |
| Entry | CONTACTLESS |
| Approval code | 07156P |
| MID | MUtka9mjqXbXZbGHJQpbTCXv |
| TID | TRbsoccxm8E1pv81U7CyibD |
| DID | DV6MauJjs1BEXPzmaPoZYDa |
## Result
**SUCCEEDED**
ARQC FC15B86E8424104A
## Amount
| | |
|---|---|
| AMOUNT | $10.00 |
| =TOTAL | $10.00 |
> I agree to pay the above total amount according to the card issuer agreement
*Thank You — Cardholder Copy*

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---
type: receipt
category: eye
person: Yanxin Lu
date: 2025-12-29
provider: Del Rey Optometry Marina Del Rey
source: lu_eye_exam_receipt_12-2025.HEIC
---
# Eye Exam Receipt — Yanxin Lu — 12/29/2025
## Store Information
- **Store:** Del Rey Optometry Marina Del Rey 10
- **Address:** 4266 Lincoln Blvd., Marina Del Rey, CA 90292-5618, United States
- **Phone:** 310-823-4595
## Receipt Details
- **Receipt #:** 3010061
- **Date:** 12/29/25 @ 10:08 AM
- **Store:** 29010 | Register: 3
- **Cashier:** Paola 330031
- **Salesperson:** 330031 (Paola)
- **Order For:** Yanxin Lu
- **Sales Order:** 10122847829010
## Line Items
| Item | Qty | Price | Amount |
|------|-----|-------|--------|
| 92015 Refraction (20500001669638) | 1 | 59.00 | 17.90 |
| 4321-INSURANCE DISCOUNT | | | (41.10) |
| Sales Order 10122847829010 [Doctor Service Addon] | | | |
| Optomap (20500001862528) | 1 | 39.00 | 0.00 |
| 4321-INSURANCE DISCOUNT | | | (39.00) |
| Sales Order 10122847829010 [Doctor Service Addon] | | | |
| 92014 Est Comprehensive (20500001985201) | 1 | 159.00 | 71.60 |
| 4321-INSURANCE DISCOUNT | | | (87.40) |
| Sales Order 10122847829010 [Doctor Service] | | | |
| ADD-ON ONLY PACKAGE ARTICLE | | | |
## Totals
| | Amount |
|---|--------|
| Subtotal | 89.50 |
| Tax | 0.00 |
| **Total** | **89.50** |
## Payment
| | Amount |
|---|--------|
| Assignment Vision Care (10122847829010) | 79.50 |
| MasterCard 4800 | 10.00 |
| Auth #: | |
| Transaction Type: Sale | |
| Entry Method: Keyed | |
| Auth Time: 10:08 AM | |
| **Change** | **0.00** |
## Notes
> Guarantee: Our goal is 100% satisfaction! If you're not completely satisfied with your purchase within the first 30 days, just let us know. We're committed to making it right.
Total Item(s) purchased: 3
*Customer Copy*