New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/9/2024 3:06:00 PM
Cost:: 35
Service:: Change Lenses
prescribed by doctor:: Dr. Moussa Shoueib
Notes:: AR 1.61

	SPH	CYL	AX	ADD
OD		-3	10
OS		-3.75	165

Date of visit:: 5/4/2025 3:06:00 PM
Cost:: 50
Service:: change lenses
prescribed by doctor:: Old RX
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD		-3	10
OS		-3.5	160

Date of visit:: 4/30/2025 6:04:00 PM
Cost:: 45
Service:: change lenses
prescribed by doctor:: Dr. Moussa Shoeib
Notes:: AR 1.61

	SPH	CYL	AX	ADD
OD		-3	10
OS		-3.5	160

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS