New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/27/2024 4:20:00 PM
Cost:: 55
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: Airlite + AR Lenses for Near only

	SPH	CYL	AX	ADD
OD	0	-0.5	160	1.25
OS	1	-0.5	20	1.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS