New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/25/2024 5:02:00 PM
Cost:
120
Service:
Frame + Lenses
prescribed by doctor:
Luna
Notes:
Tom Tailor Frame + AR + Transition
SPH
CYL
AX
ADD
OD
-0.5
-3.5
80
OS
0.25
-4
90
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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