New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/16/2025 3:03:00 PM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: plastic frame, AR

	SPH	CYL	AX	ADD
OD	4.5	-1.25	100
OS	4.5	-1	60

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS