New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/24/2024 5:06:00 PM
Cost:
60
Service:
Airlite Frame + Lenses
prescribed by doctor:
Old Rx
Notes:
For Near ONLY
SPH
CYL
AX
ADD
OD
2.25
2.75
OS
1.25
2.75
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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