New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/16/2024 7:12:00 PM
Cost:: 45
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: For Near ONLY

	SPH	CYL	AX	ADD
OD	0	-1.5	80	1.25
OS	0	-1.25	160	1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS