New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/5/2024 6:16:00 PM
Cost:: 50
Service:: Change Lenses
prescribed by doctor:: Luna
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD		-0.75	180
OS		-0.25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS