New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/1/2025 2:17:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Metalic Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	0	-0.5	85
OS	0	-0.75	90

Date of visit:: 3/3/2025 4:24:00 PM
Cost:: 40
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: AR

	SPH	CYL	AX	ADD
OD	0	-0.5	85
OS	0	-0.75	90

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS