New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/12/2024 3:25:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Old RX
Notes:: AR Transition

	SPH	CYL	AX	ADD
OD	-1
OS	0

Date of visit:: 4/12/2025 12:46:00 PM
Cost:: 75
Service:: Frame+Lenses
prescribed by doctor:: Old RX
Notes:: AR transition W9

	SPH	CYL	AX	ADD
OD	-1
OS	0

Date of visit:: 5/10/2025 12:52:00 PM
Cost:: 50
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: AR FOR NEAR

	SPH	CYL	AX	ADD
OD	0.5
OS	0

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS