New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/9/2024 1:43:00 PM
Cost:: 65
Service:: Change Lenses
prescribed by doctor:: Aya
Notes:: AR NEAR(50$) +Far (15$)

	SPH	CYL	AX	ADD
OD	1.25			2.5
OS	0.75			2.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS