New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/30/2024 4:15:00 PM
Cost:: 15
Service:: Change lenses AR
prescribed by doctor:: Aya
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	1.5
OS	2	-1.5	90

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS