New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/2/2025 3:06:00 PM
Cost:: 110
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Transition AR

	SPH	CYL	AX	ADD
OD	-2	-0.5	180
OS	-2.75	-0.25	173

Date of visit:: 6/3/2025 11:02:00 AM
Cost:: 120
Service:: Frame+Lenses
prescribed by doctor:: oldrx
Notes:: AR, idol cut telween shamse 50 percent

	SPH	CYL	AX	ADD
OD	-2	-0.5	180
OS	-2.75	-0.25	173

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS