New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/14/2024 11:53:00 AM
Cost:: 140
Service:: 2 Frame + 2 lenses Transtion w9
prescribed by doctor:: Aya
Notes:

	SPH	CYL	AX	ADD
OD	-0.25	-0.25	120
OS		-1.5	170

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS