New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/20/2024 5:25:00 PM
Cost:: 40
Service:: Change Lenses AR + Transition
prescribed by doctor:: Luna
Notes:: Transition AR

	SPH	CYL	AX	ADD
OD	-0.25	-2	100
OS	-0.5	-1.25	166

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS