New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/6/2024 2:37:00 PM
Cost:: 140
Service:: 2 Airlite + lenses Ar+ Transtion lenses
prescribed by doctor:: Dr. MOHAMMAD ASSAF
Notes:

	SPH	CYL	AX	ADD
OD		1.25	5	150
OS	0.75	1.25	165	1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS