New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/6/2024 2:27:00 PM
Cost:: 120
Service:: 2 frames + 2 lenses
prescribed by doctor:: Australian Doctor
Notes:: AR (NEAR) Transition AR (DISTANCE)

	SPH	CYL	AX	ADD
OD	0			1
OS	-0.25			1

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS