New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/9/2025 11:18:00 AM
Cost:: 0
Service:: Frame + Lenses
prescribed by doctor:: old Rx
Notes:

	SPH	CYL	AX	ADD
OD	0	-1	110
OS	-2.5	-2	66

Date of visit:: 12/9/2025 12:54:00 PM
Cost:: 100
Service:: Frame+Lenses
prescribed by doctor:: OLD Rx
Notes:: TELWEEN Chamse david Backham

	SPH	CYL	AX	ADD
OD		-1	110
OS	-2.5	-2	66

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS