New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/3/2025 11:32:00 AM
Cost:
130
Service:
Frame + Lenses
prescribed by doctor:
old RX
Notes:
plastic frame, infinity white +montage idol cut
SPH
CYL
AX
ADD
OD
0
-0.5
140
2.5
OS
0
-0.75
95
2.5
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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