New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/21/2024 5:29:00 PM
Cost:: 35
Service:: Change lenses AR
prescribed by doctor:: Luna
Notes:: 1.61 AR

	SPH	CYL	AX	ADD
OD	-4.5	-0.25	0
OS	-4.5	-0.25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS