New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/1/2024 1:36:00 PM
Cost:
14
Service:
Clear 55 contact lenses
prescribed by doctor:
Old Rx
Notes:
With NEO PLUS 1st time wearer
SPH
CYL
AX
ADD
OD
-4
OS
-3
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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