New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/22/2025 2:12:00 PM
Cost:: 500000
Service:: refraction
prescribed by doctor:
Notes:

	SPH	CYL	AX	ADD
OD	-5.5	-0.25	3
OS	-5.75	-0.25	124

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS