New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/4/2024 4:07:00 PM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: Old RX
Notes:: we changed cyl in left eye to (-2.50)

	SPH	CYL	AX	ADD
OD	-3.75	-2	150
OS	-4	-3	170

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS