New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/7/2024 2:28:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Dr. Mirna Salami
Notes:: anti-blue green coated + Metal

	SPH	CYL	AX	ADD
OD		-0.75	180
OS		-0.5	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS