New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/16/2024 12:58:00 PM
Cost:: 65
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Stainless Steel Frame + AR 1.67 high index

	SPH	CYL	AX	ADD
OD	-6.25
OS	-5.75

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS