New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/10/2024 5:54:00 PM
Cost:: 25
Service:: Change Lenses
prescribed by doctor:: Old RX
Notes:: AR Lenses 1.61

	SPH	CYL	AX	ADD
OD	-2.75	-0.5	100
OS	-2.5	-0.5	50

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS