New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/26/2024 2:50:00 PM
Cost:: 11
Service:: Clear 55 contact lenses
prescribed by doctor:: Aya
Notes:: Equivalence OD: -2.00 OS: -3.75

	SPH	CYL	AX	ADD
OD	-1.5	-1	90
OS	-3.25	-1	75

Date of visit:: 1/3/2025 4:34:00 PM
Cost:: 11
Service:: Contact Lenses
prescribed by doctor:: Luna
Notes:: PolyView + Clear View (Spherical Equivalence)

	SPH	CYL	AX	ADD
OD	-2.25
OS	-3.25

Date of visit:: 1/4/2025 5:02:00 PM
Cost:: 70
Service:: Frame+Lenses
prescribed by doctor:: Luna
Notes:: AR Lenses + Compact + Metal Frame

	SPH	CYL	AX	ADD
OD	-1	-0.75	90
OS	-2.75	-0.5	80

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS