Rx
Clearview Eye Care
Suite 204, 1180 Granville Street · Vancouver, BC V6Z 1M3
Tel: (604) 555-0192  ·  clearvieweyecare.ca
Eyeglass Prescription
Patient Name
Alex Chen
Date of Exam
March 1, 2026
Date of Birth
Sept 17, 1998
Refraction Data — Distance Vision
Eye Sphere (D) Cylinder (D) Axis (°) Add (D) Prism VA
OD  Right
−3.25 −0.75 2 — — 20/20
OS  Left
−3.25 −0.50 5 — — 20/20
Pupillary Distance
OD (Far)
33.0
OS (Far)
33.0
Total PD
66.0
Fitting Parameters
OD FH
27mm
OS FH
27mm
Vertex
12mm
Clinical Notes
Single vision distance lenses recommended. Patient presents with mild myopia and low astigmatism OU. No significant change from previous prescription. Next examination recommended in 12 months.
Authorizing Optometrist
Dr. Sarah Mitchell, O.D.  ·  Lic. BC-48821
Date Issued
Clearview Eye Care · Vancouver, BC
This prescription is valid for 24 months from the date of issue. Not valid without authorizing optometrist signature and clinic stamp.