New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/4/2025 1:27:00 PM
Cost:: 250
Service:: Change Lenses
prescribed by doctor:: Old RX
Notes:: AR 1.74

	SPH	CYL	AX	ADD
OD	-11.75	-1	170
OS	-12.25	-0.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS