New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/10/2024 5:58:00 PM
Cost:: 150
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: US-Design FMC Transition + Montage

	SPH	CYL	AX	ADD
OD	0.75	-0.75	77	2.25
OS		-1	160	2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS