New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/30/2025 12:08:00 PM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Transition AR

	SPH	CYL	AX	ADD
OD	-1.5	-0.5	100
OS	-0.75	-1.5	78

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS