New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/23/2024 5:48:00 PM
Cost:
60
Service:
Frame + Lenses
prescribed by doctor:
Aya
Notes:
Very Sick Px + AR 1.67 for Far
SPH
CYL
AX
ADD
OD
-8
-0.75
70
2.5
OS
-6
-2
170
2.5
Date of visit:
4/24/2024 5:50:00 PM
Cost:
25
Service:
Change Lenses
prescribed by doctor:
Aya
Notes:
For Near Only
SPH
CYL
AX
ADD
OD
2.5
OS
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
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