New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/20/2025 2:23:00 PM
Cost:
150
Service:
2Frame +2 Lenses
prescribed by doctor:
nancy
Notes:
AR transition both frames, Tomford , Raybun
SPH
CYL
AX
ADD
OD
2.25
-0.5
85
OS
2.25
-0.5
105
Date of visit:
11/3/2025 1:11:00 PM
Cost:
50
Service:
change lenses
prescribed by doctor:
Old RX
Notes:
AR TRANSITION W9
SPH
CYL
AX
ADD
OD
2.25
-0.5
85
OS
2.25
-0.5
105
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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