New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/5/2024 4:50:00 PM
Cost:
90
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
Vincent Chase + Transition AR W9
SPH
CYL
AX
ADD
OD
-3.75
-0.75
95
OS
-3
-0.75
120
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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