New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
7/21/2025 1:53:00 PM
Cost:
180
Service:
Frame + Lenses
prescribed by doctor:
Nancy
Notes:
optical frame, progressive infinity FMC+ montage
SPH
CYL
AX
ADD
OD
0
-1.5
75
2.25
OS
0
-1.5
85
2.25
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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