New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/6/2025 1:47:00 PM
Cost:
25
Service:
AR
prescribed by doctor:
OLD RX
Notes:
AR
SPH
CYL
AX
ADD
OD
-1
-1.25
99
OS
-0.5
-1
90
Date of visit:
6/12/2026 10:37:00 AM
Cost:
Service:
Frame+Lenses
prescribed by doctor:
Zaynab + Old Rx
Notes:
AR for far only
SPH
CYL
AX
ADD
OD
-0.5
-1.5
105
2
OS
-0.5
-1.25
101
2
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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