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FEA FINISHED RX ORDER FORM
AADCO MEDICAL
FEA FINISHED RX ORDER FORM
OVERALL NOTES
Account Num:
Contact Person
Customer Number
PART NUM
LENS INFORMATION
LENS STYLE
MATERIAL
FACTORY ITEM
THICKNESS
LENS TYPE
CONVENTIONAL
FREE FORM
Notes
PLEASE EDGE AND INSTALL 1 PAIR OF UNCUT LESNES INTO FRAME SUPPLIED BY AADCO
Show
Dist - OD
Add - OD
Dist - OS
Add - OS
EDGE TYPE
ZYL
METAL
RIMLESS
DRILLED RIMLESS
C SIZE
SPORT GLASS
WRAP
STYLE TYPE
SUPPLY
SAFETY
ENCLOSED
TO FOLLOW
EDGE ONLY
DIST - OD
Sphere
Axis
Cylinder
Prism
Special Base Curve
ADD - OD
Power
Dist Dec
Inset
Total Dec
Seg Height
Optical Center
PD Distance
PD Near
DIST - OS
Sphere
Axis
Prism
Cylinder
Special Base Curve
ADD - OS
Power
Dist Dec
Inset
Total Dec
Seg Height
Optical Center
PD Distance
PD Near
Frame Data
Frame Name - Manufacturer Number - Color
Eye Size (A)
DBL (Bridge)
Vertical (B)
Temple
Longest Point (ED)
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