New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/16/2024 12:48:00 PM
Cost:: 60
Service:
prescribed by doctor:
Notes:: Bifocal

	SPH	CYL	AX	ADD
OD	1.25			2.5
OS	1			2.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS