New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
9/17/2024 5:39:00 PM
Cost:
35
Service:
Frame + Lenses
prescribed by doctor:
OLD RX
Notes:
Pro Lenses + Acetate Frame
SPH
CYL
AX
ADD
OD
0.25
2
150
OS
1.5
-3
95
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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