New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/27/2025 5:39:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Oskar Levinski + AntiBlue

	SPH	CYL	AX	ADD
OD		-0.25	180
OS		-0.5	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS