New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
8/14/2024 11:34:00 AM
Cost:
60
Service:
Change lenses for far TRANSTION + FRAME+NEAR AR LENSES
prescribed by doctor:
Dr. MOHAMMAD ASSAF
Notes:
SPH
CYL
AX
ADD
OD
3.5
8
3
OS
2.5
180
3
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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