New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/6/2024 6:26:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR 1.61

	SPH	CYL	AX	ADD
OD	-4	-0.5	173
OS	-3.75	-0.5	2

Date of visit:: 11/4/2025 11:46:00 AM
Cost:: 40
Service:: Change Lenses
prescribed by doctor:: Dr. Ali Alhaj
Notes:: AR compacted

	SPH	CYL	AX	ADD
OD	-4.25	-0.5	170
OS	-4	-0.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS