New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/26/2024 11:28:00 AM
Cost:
75
Service:
frame iris+ transtion ar modern
prescribed by doctor:
aya
Notes:
SPH
CYL
AX
ADD
OD
-1.25
-0.5
160
OS
-0.25
-0.5
110
Date of visit:
3/30/2024 1:57:00 PM
Cost:
15
Service:
Contact Lenses
prescribed by doctor:
Aya
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
-1.25
-0.5
160
OS
-0.25
-0.5
110
Date of visit:
5/11/2024 12:46:00 PM
Cost:
15
Service:
change lenses
prescribed by doctor:
Aya
Notes:
Antiblue
SPH
CYL
AX
ADD
OD
-1.25
-0.5
160
OS
-0.25
-0.5
110
Date of visit:
8/15/2024 6:41:00 PM
Cost:
90
Service:
Frame + Lenses
prescribed by doctor:
Old Rx
Notes:
Cartier Frame + Transition W9
SPH
CYL
AX
ADD
OD
-1.25
-0.5
155
OS
-0.25
-0.5
100
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
Back to List