New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/13/2025 5:01:00 PM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: old rx
Notes:: AR Lenses, and took clear 55 (-7.00,-7.00) for 10 dollar

	SPH	CYL	AX	ADD
OD	-6	-2	15
OS	-5.5	-2.5	165

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS