New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 10/31/2025 1:35:00 PM
Cost:: 60
Service:: frame +lenses
prescribed by doctor:: Old RX
Notes:: AR Lenses 1.61

	SPH	CYL	AX	ADD
OD	-1.25	-2.25	180
OS	-0.25	-2.5	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS