New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/27/2025 4:35:00 PM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Transition AR W9

	SPH	CYL	AX	ADD
OD	0	-0.75	180
OS	1.75	-1.25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS