New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/25/2024 3:03:00 PM
Cost:: 15
Service:: change lens
prescribed by doctor:: luna
Notes:: change one lens 1 lens tinted

	SPH	CYL	AX	ADD
OD	-2	-1.75	90
OS

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS