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

Date of visit:: 1/12/2025 1:58:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Old Rx
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-0.75
OS	-0.75	-0.5	30

Date of visit:: 6/27/2025 6:49:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: OLD RX
Notes:: Sting Frame + AR Lenses

	SPH	CYL	AX	ADD
OD	-0.75
OS	-0.75	-0.5	30

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS