New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/18/2025 1:46:00 PM
Cost:: 55
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: acetate frame AR For near (for near -0.25 is removed)

	SPH	CYL	AX	ADD
OD	1.5	-0.25	75	2.25
OS	0	-0.25	142	2.25

Date of visit:: 5/12/2025 5:18:00 PM
Cost:: 10
Service:: change 1 lens
prescribed by doctor:: Old RX
Notes:: change 1 lens left eye

	SPH	CYL	AX	ADD
OD
OS	2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS