New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/26/2026 2:53:00 PM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: Antiblue

	SPH	CYL	AX	ADD
OD	0.5	-1.75	28
OS	0.5	-0.75	144

Date of visit:: 1/27/2026 3:05:00 PM
Cost:: 130
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: AR TRANSITION W9

	SPH	CYL	AX	ADD
OD	0.5	-1.75	28
OS	0.5	-0.75	144

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS