New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/11/2025 4:41:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR Transition W9

	SPH	CYL	AX	ADD
OD	-1	-0.5	160
OS	-1

Date of visit:: 11/22/2025 10:27:00 AM
Cost:: 45
Service:: Change Lenses
prescribed by doctor:: Luna
Notes:: AR

	SPH	CYL	AX	ADD
OD	-1.25	-1	166
OS	-1.5	-0.25	45

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS