New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/28/2024 10:21:00 AM
Cost:: 75
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: Polycarbonate AR for Reading

	SPH	CYL	AX	ADD
OD				1.75
OS				1.75

Date of visit:: 6/25/2024 6:06:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: Anti-Blue PLANO

	SPH	CYL	AX	ADD
OD	0
OS	0

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS