New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/21/2025 4:15:00 PM
Cost:: 0
Service:: Refraction
prescribed by doctor:: Nancy
Notes:

	SPH	CYL	AX	ADD
OD	0.75	-0.25	45
OS	1	-0.25	141

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS