New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/12/2024 1:26:00 PM
Cost:: 55
Service:: Frame + Lenses
prescribed by doctor:
Notes:: AntiBlue Lenses

	SPH	CYL	AX	ADD
OD	-1	-2.25	170
OS	-0.25	-2.5	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS