New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/21/2025 6:07:00 PM
Cost:: 25
Service:: Change 1 Lens
prescribed by doctor:: Dr. Carole Cherfan
Notes:: AR 1.75 for OS

	SPH	CYL	AX	ADD
OD
OS	-6	0.75	130

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS