New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/9/2025 11:20:00 AM
Cost:: 80
Service:: Change Lenses
prescribed by doctor:: Nancy
Notes:: 2frames , AR

	SPH	CYL	AX	ADD
OD	-0.25	-0.5	105	1.25
OS	0.25	-0.5	80	1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS