New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/17/2024 1:01:00 PM
Cost:: 25
Service:: Frame + Lenses
prescribed by doctor:: Dr. Mahmmoud Jaroudi
Notes:: Vouge Eyewear + AR Lenses

	SPH	CYL	AX	ADD
OD	1.75	0.75	60
OS	1.5	1	110

Date of visit:: 12/25/2024 5:06:00 PM
Cost:: 20
Service:: Change lenses
prescribed by doctor:: Dr. Mahmoud Jaroudi
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	2.25
OS	2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS