New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/3/2024 5:30:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:
Notes:: FLEX + LENSES

	SPH	CYL	AX	ADD
OD	5.25	0.75	145
OS	4.5	1.5	60

Date of visit:: 4/8/2024 1:22:00 PM
Cost:: 40
Service:: Frame+Lenses
prescribed by doctor:: Dr. Bakri Rihawi (Syria)
Notes:: Airlite+Lenses

	SPH	CYL	AX	ADD
OD	6	-1	40
OS	6	-1	155

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS