New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/5/2024 5:56:00 PM
Cost:: 15
Service:: Change Lenses
prescribed by doctor:: Luna
Notes:: AR

	SPH	CYL	AX	ADD
OD		-1.5	135	180
OS		-0.75	25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS