New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/26/2024 3:52:00 PM
Cost:
0
Service:
Frame + Lenses
prescribed by doctor:
Old Rx
Notes:
Airlite + Infinity + Transition + FMC
SPH
CYL
AX
ADD
OD
5.5
1.75
OS
5.5
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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