New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/16/2024 11:06:00 AM
Cost:: 80
Service:: Fila Frame+ Transtion Lenses
prescribed by doctor:: OLD RX
Notes:

	SPH	CYL	AX	ADD
OD	-1.5	-0.25	5
OS	-1.5	-0.5	60

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS