New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/15/2025 3:16:00 PM
Cost:
75
Service:
Frame + Lenses
prescribed by doctor:
Nancy
Notes:
metal frame, bifocal hassan cut
SPH
CYL
AX
ADD
OD
2.25
1.75
OS
2.25
1.75
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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