New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
8/26/2024 1:40:00 PM
Cost:
160
Service:
2 Frame + 2 Lenses
prescribed by doctor:
Dr. Karim Tomey
Notes:
Transition for Distance and AR for Near
SPH
CYL
AX
ADD
OD
0
2.5
OS
-0.5
1.75
160
2.5
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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