New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/19/2024 1:53:00 PM
Cost:
70
Service:
Frame + Lenses
prescribed by doctor:
OLD RX
Notes:
AR Transition
SPH
CYL
AX
ADD
OD
-2.25
-0.75
105
OS
-2.25
-0.75
65
Date of visit:
12/19/2024 1:32:00 PM
Cost:
30
Service:
change frame
prescribed by doctor:
0ld Rx
Notes:
change frame
SPH
CYL
AX
ADD
OD
-2.25
-0.75
105
OS
-2.25
-0.75
65
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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