New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/11/2023 5:33:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: Airlite Plano

	SPH	CYL	AX	ADD
OD
OS

Date of visit:: 7/15/2024 5:34:00 PM
Cost:: 100
Service:: Frame+Lenses
prescribed by doctor:: Old RX
Notes:: AR + Transition PLANO

	SPH	CYL	AX	ADD
OD
OS

Date of visit:: 1/14/2025 3:29:00 PM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: PLANO TRANSITION OU

	SPH	CYL	AX	ADD
OD
OS

Date of visit:: 10/23/2025 5:49:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Airlite + AR Lenses PLANO AR

	SPH	CYL	AX	ADD
OD	0
OS	0

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS