New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/19/2024 2:29:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Old RX
Notes:: AR Lenses + Metal Frame Cat Eye

	SPH	CYL	AX	ADD
OD	0.25	-0.75	180
OS		-0.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS