New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/20/2024 10:54:00 AM
Cost:: 500000
Service:: Eye Exam
prescribed by doctor:: Luna
Notes:

	SPH	CYL	AX	ADD
OD	-0.75	-0.25	100
OS	-1

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS