New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/25/2024 1:38:00 PM
Cost:: 15
Service:: Change lenses AR
prescribed by doctor:: Aya
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-0.25	-1	5
OS	-0.5	-0.5	15

Date of visit:: 12/19/2025 12:19:00 PM
Cost:: 40
Service:: Frame+Lenses
prescribed by doctor:: Nancy
Notes:: AR

	SPH	CYL	AX	ADD
OD	-0.5	-0.25	180
OS	-0.5	-0.25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS