New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/1/2025 4:11:00 PM
Cost:: 40
Service:: 2 Pairs of AR Lenses on OLD FRAMES
prescribed by doctor:: Nancy
Notes:: AR Lenses ONE for Dist ONE for Near

	SPH	CYL	AX	ADD
OD	-0.5	-1.75	170	1.75
OS	0	-1	175	1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS