New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/3/2024 11:03:00 AM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: AR

	SPH	CYL	AX	ADD
OD	-1.5	-1	10
OS	-2.25	-0.25	150

Date of visit:: 4/10/2025 5:55:00 PM
Cost:: 12
Service:: Contact Lenses
prescribed by doctor:: OLD Rx
Notes:: Polyview + Clear View Solution

	SPH	CYL	AX	ADD
OD	-2
OS	-2.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS