New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/19/2025 12:00:00 PM
Cost:
100
Service:
2Frame + Lenses
prescribed by doctor:
Nancy
Notes:
Both Airlite ,AR 1.61 One black frame for far and one gray for near (for near without _0.5 astigmat)
SPH
CYL
AX
ADD
OD
6
2
OS
6.25
-0.5
85
2
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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