New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/30/2024 5:57:00 PM
Cost:
200
Service:
Progressive Synchrony Easy Adapt
prescribed by doctor:
Dr. Rola Hamam
Notes:
AR IDOL + MONTAGE
SPH
CYL
AX
ADD
OD
1.25
-1.25
100
2.75
OS
3.5
-1.25
85
2.75
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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