New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/19/2024 1:56:00 PM
Cost:: 140
Service:: Frame + Lenses
prescribed by doctor:: Luna
Notes:: Gucci Frame + AR Lenses (She's a 6 year post PRK px)

	SPH	CYL	AX	ADD
OD	-1
OS	-1

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS