New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/3/2024 4:20:00 PM
Cost:: 600000
Service:: Change One Lens
prescribed by doctor:
Notes:: Changed ONE lens ONLY

	SPH	CYL	AX	ADD
OD
OS	-1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS