New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/16/2024 6:25:00 PM
Cost:
35
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
Tench Frame+ AR Lenses
SPH
CYL
AX
ADD
OD
0.5
-1.5
90
OS
0.5
-1.25
66
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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