New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/26/2025 3:47:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: OLD RX
Notes:: MK NYLOR + Lenses AR OD->1.67 OS-> Normal

	SPH	CYL	AX	ADD
OD	-5	-0.25	175
OS	-1.75	-0.75	20

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS