New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/6/2024 3:52:00 PM
Cost:
30
Service:
2 Change Lenses (Dist & intermediate)
prescribed by doctor:
Aya
Notes:
Intermediate OD: 0.75 OS: 0.75-0.50x30
SPH
CYL
AX
ADD
OD
-0.75
2
OS
-0.75
-0.5
30
2
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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