New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/13/2024 4:29:00 PM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: Puma Frame + AR TRANSITION W9

	SPH	CYL	AX	ADD
OD	0.5
OS	0.25	-1	100

Date of visit:: 1/2/2026 12:54:00 PM
Cost:: 40
Service:: Change Lenses
prescribed by doctor:: Luna
Notes:: AR + Transition

	SPH	CYL	AX	ADD
OD	0.5
OS	0.75	-1.5	100

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS