New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/13/2024 1:27:00 PM
Cost:: 60
Service:: frame + transtion lenses ar
prescribed by doctor:: Old RX
Notes:: AFRICA

	SPH	CYL	AX	ADD
OD	-3
OS	-3

Date of visit:: 12/27/2025 12:04:00 PM
Cost:: 12
Service:: Clear 55
prescribed by doctor:: Old RX
Notes:: She always takes clear 55

	SPH	CYL	AX	ADD
OD	-4
OS	-3.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS