New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/4/2024 7:04:00 PM
Cost:: 15
Service:: Change lenses AR
prescribed by doctor:: Old Rx
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-1	-0.75	180
OS	-0.75	-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