New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/7/2024 4:20:00 PM
Cost:: 20
Service:: Change Lenses
prescribed by doctor:: OLD RX
Notes:: Nancy

	SPH	CYL	AX	ADD
OD	-2	-0.5	135
OS	-2

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS