New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/12/2024 3:44:00 PM
Cost:: 35
Service:: Change lenses AR
prescribed by doctor:
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-1.25	-2.5	25
OS	-1.5	-3	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS