New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/15/2024 3:17:00 PM
Cost:
50
Service:
Frame + Lenses
prescribed by doctor:
Aya
Notes:
ONLY TRANSITION AR FOR DISTANCE
SPH
CYL
AX
ADD
OD
1.5
-2
80
2
OS
2
-1.5
90
2
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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