New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/28/2025 12:05:00 PM
Cost:: 170
Service:: frame +lenses
prescribed by doctor:: Nancy
Notes:: progressive infinity FMC+Montage

	SPH	CYL	AX	ADD
OD	1.25			2.25
OS	1			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