New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/21/2024 3:12:00 PM
Cost:: 80
Service:: Airlite + TRANSTION LENSES
prescribed by doctor:: Aya
Notes:

	SPH	CYL	AX	ADD
OD	-1
OS	-2.5

Date of visit:: 3/14/2025 4:52:00 PM
Cost:: 0
Service:: Change Lenses 2 Pairs
prescribed by doctor:: Dr. Sabrina Rammal
Notes:: Did Cat Sx in both eyes and Dr. Sabrina prescribed Rx for D+N

	SPH	CYL	AX	ADD
OD	-0.75			2
OS	-0.75	-0.75	50	2

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS