New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/15/2025 3:00:00 PM
Cost:
300
Service:
Frame + Lenses + 3 Sunglasses
prescribed by doctor:
Px Himself
Notes:
Px has a cornea transplant and took 1 RX PLANO and 3 Sunglasses
SPH
CYL
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ADD
OD
0
OS
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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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