New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 10/15/2025 2:07:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR

	SPH	CYL	AX	ADD
OD	0	-4	180
OS	0	-4	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS