New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/4/2025 2:49:00 PM
Cost:
50
Service:
Frame + Lenses
prescribed by doctor:
OLD RX
Notes:
Amichi Frame + AR TRANSITION
SPH
CYL
AX
ADD
OD
-0.5
-1.5
102
OS
0
-2.75
80
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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