New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/30/2025 2:45:00 PM
Cost:: 40
Service:: change lenses
prescribed by doctor:: old rx
Notes:: AR 1.61

	SPH	CYL	AX	ADD
OD	3.25
OS	4.5	-1	78

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS