New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/20/2023 2:14:00 PM
Cost:: 8
Service:: Contact Lenses
prescribed by doctor:: Aya
Notes:: Toric = yet she takes equivalency POLYVIEW

	SPH	CYL	AX	ADD
OD	-1	-0.75	160
OS	-1	-1.25	15

Date of visit:: 3/2/2024 2:16:00 PM
Cost:: 11
Service:: Contact Lenses
prescribed by doctor:: Aya
Notes:: CLEAR 55 Equivalency for Astig

	SPH	CYL	AX	ADD
OD	-1	-0.75	160
OS	-1	-1.25	15

Date of visit:: 5/1/2024 12:19:00 PM
Cost:: 20
Service:: Toric Lenses Polyveiw
prescribed by doctor:: Aya
Notes:: Toric Lenses Polyveiw

	SPH	CYL	AX	ADD
OD	-1	-0.75	160
OS	-1	-1.25	15

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS