New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/16/2024 3:21:00 PM
Cost:: 25
Service:: Change lenses
prescribed by doctor:: Nancy
Notes:: Anti blue

	SPH	CYL	AX	ADD
OD	-1.25	-1.5	180
OS	-1.5	-1	180

Date of visit:: 8/4/2026 6:34:00 PM
Cost:: 14
Service:: Contact lenses
prescribed by doctor:: Old Rx
Notes:: Clear 55 , we did spherical equvilance and gave -2.00 OU

	SPH	CYL	AX	ADD
OD	-2
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