New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/31/2025 2:25:00 PM
Cost:: 120
Service:: frame +lenses
prescribed by doctor:: Old RX
Notes:: oliver people compacted AR

	SPH	CYL	AX	ADD
OD	4	-2.25	170
OS	4.25	-2	15

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS