New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/23/2024 1:52:00 PM
Cost:: 55
Service:: frame iris+ ar modern
prescribed by doctor:: luna
Notes:

	SPH	CYL	AX	ADD
OD	-2	-0.25	110
OS	-2.25

Date of visit:: 4/5/2024 4:47:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Old RX
Notes:: Iris+ Transition AR

	SPH	CYL	AX	ADD
OD	-2	-0.25	110
OS	-2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS