New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/8/2024 3:55:00 PM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: Airlite + AR Lenses 1.67

	SPH	CYL	AX	ADD
OD	-9	-1.25	180
OS	-4	-0.5	40

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS