Patient Information

Sarah Johnson
DOB: 03/15/1985
Phone: (555) 123-4567
Insurance: VSP Vision Care
Member ID: 123456789

Active Prescription

SPH
CYL
Axis
Add
OD (Right)
-2.25
-0.75
180
+2.00
OS (Left)
-2.50
-0.50
175
+2.00
Dr. Michael Chen Expires: 07/15/2026

Order Configurator

Click any card to configure. Jump between sections in any order.

3
Completed
2
In Progress
3
Not Started
👓
Frame Selection
Choose frame style and size
Frame Image
Desmon - Oliver Peoples
Tortoise • Size: S (128mm) • Acetate
Retail: $454.00 Copay: $210.00
🔄
Lens Type
Vision correction type
Progressive Lenses
Retail: $200.00 Copay: $80.00
Lens Design
Specific lens brand/model
Varilux XR Track
Retail: $349.00 Copay: $185.00
💎
Lens Material
Thickness and weight
Selecting...
Choose material
🛡️
Coatings
Anti-reflective & protection
Partial selection
Crizal Sapphire HR selected
🌞
Lens Options
Transitions, tints, etc.
Not configured
Optional features
!
📏
Measurements
PD, fitting height, etc.
Missing required data
Progressive requires fitting height
💳
Insurance Benefits
Coverage verification
Not verified
VSP Vision Care
⚠️ Order cannot be submitted: Missing required measurements for progressive lenses. Please complete the Measurements section.
Live Order Summary
Updates instantly as you configure
Item Description
Retail
Patient
Frame
Desmon - Oliver Peoples
$454.00
$210.00
Item Description
Retail
Patient
Lens Type: Progressive Lenses
$200.00
$80.00
Progressive Lenses
Varilux XR Track
$349.00
$185.00
⚡ Material: Pending selection
⚡ Coating: Crizal Sapphire HR
$165.00
$40.00
○ Options: Not configured
⚠️ Incomplete Items:
  • Lens Material selection required
  • Measurements missing (PD, Fitting Height)
  • Insurance verification pending
Subtotal (Retail) $968.00
Insurance Coverage -$533.00
Discounts Applied -$0.00
Patient Responsibility $435.00