New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
7/16/2024 5:31:00 PM
Cost:
80
Service:
Frame + Lenses
prescribed by doctor:
Old RX
Notes:
AR + transition + airlite
SPH
CYL
AX
ADD
OD
2.5
0.5
90
OS
2.5
0.5
90
Date of visit:
7/3/2026 2:57:00 PM
Cost:
80
Service:
change lenses
prescribed by doctor:
Old RX
Notes:
transition A.R. 1.67
SPH
CYL
AX
ADD
OD
3
-0.5
180
OS
3
-0.5
5
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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