New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/13/2024 4:29:00 PM
Cost:: 10
Service:: Contact Lenses Clear 55
prescribed by doctor:: Luna
Notes:: used to take polyview , now clear 55

	SPH	CYL	AX	ADD
OD	-2
OS	-2

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS