---
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.