New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/27/2024 1:05:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	0.5	-1.75	27	27
OS	1	-1.75	137	137

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS