New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/17/2024 2:51:00 PM
Cost:
60
Service:
Frame + Lenses
prescribed by doctor:
Luna
Notes:
Airlite, Antiblue green coated
SPH
CYL
AX
ADD
OD
2.75
-1.25
30
OS
1.75
-0.75
160
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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