New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/10/2024 12:02:00 PM
Cost:: 55
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR 1.61

	SPH	CYL	AX	ADD
OD	4
OS	4

Date of visit:: 1/24/2025 2:13:00 PM
Cost:: 80
Service:: Frame+Lenses
prescribed by doctor:: nancy
Notes:: Hizo frame , AR TRANSITION W9

	SPH	CYL	AX	ADD
OD	2.75	-1.5	85
OS	2.75	-1.25	90

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS