New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/18/2025 5:08:00 PM
Cost:: 35
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Metallic frame+AR

	SPH	CYL	AX	ADD
OD	-1	-0.25	170
OS	-0.75	-0.25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS