New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/21/2024 5:26:00 PM
Cost:
60
Service:
Frame + Lenses
prescribed by doctor:
Luna
Notes:
Airlite + AR Lenses
SPH
CYL
AX
ADD
OD
-0.5
-0.75
10
OS
-0.5
-0.5
165
Date of visit:
1/15/2026 3:26:00 PM
Cost:
30
Service:
Frame+Lenses
prescribed by doctor:
Old RX
Notes:
Antiblue Green coated
SPH
CYL
AX
ADD
OD
-0.5
-0.75
10
OS
-0.5
-0.5
165
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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