New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/5/2024 5:08:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Old Rx
Notes:: Paid in LBP (AR)

	SPH	CYL	AX	ADD
OD	-1.25	-1.75	20
OS	-1.25	-1.75	160

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS