New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/10/2024 3:42:00 PM
Cost:: 50
Service:: Change Lenses
prescribed by doctor:
Notes:: Compact AR

	SPH	CYL	AX	ADD
OD	-12.5	-1	40
OS	-9	-0.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS