New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/30/2024 4:46:00 PM
Cost:: 30
Service:: Change Lenses
prescribed by doctor:: Dr. Alame
Notes:: AR + transition

	SPH	CYL	AX	ADD
OD	-0.75	-0.75	50
OS	-0.25	-0.5	170

Date of visit:: 2/1/2024 4:48:00 PM
Cost:: 0
Service:
prescribed by doctor:
Notes:: TOMMY HILIFIGER SAME COLOR

	SPH	CYL	AX	ADD
OD	-0.75	-0.75	50
OS	-0.25	-0.5	170

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS