New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/8/2024 4:24:00 PM
Cost:: 15
Service:: Change Lenses
prescribed by doctor:: Old RX
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-0.5	-1.5	10
OS	-0.5	-1.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS