New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/25/2026 1:16:00 PM
Cost:
20
Service:
Change Lenses
prescribed by doctor:
Nancy(old Rx)
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
2.25
-1.25
152
OS
3
-1
17
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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