New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/21/2024 2:35:00 PM
Cost:
8
Service:
Polyview CL
prescribed by doctor:
Old Rx
Notes:
+ Eyedia Solution
SPH
CYL
AX
ADD
OD
-1.25
OS
-1.75
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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