New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/15/2025 5:08:00 PM
Cost:
200
Service:
change lenses
prescribed by doctor:
old Rx
Notes:
progressive pravious top AR
SPH
CYL
AX
ADD
OD
2.25
0.5
30
2.5
OS
0.75
1.75
150
2.5
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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