New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/20/2025 12:02:00 PM
Cost:: 5
Service:: refraction
prescribed by doctor:: luna
Notes:: he needs rx for army

	SPH	CYL	AX	ADD
OD	0.25
OS	0	-0.5	160

Date of visit:: 2/5/2025 12:10:00 PM
Cost:: 15
Service:: change lenses
prescribed by doctor:: luna
Notes:: AR

	SPH	CYL	AX	ADD
OD	0.25
OS	0	-0.5	160

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS