New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/17/2024 4:27:00 PM
Cost:: 8
Service:: Contact Lenses
prescribed by doctor:
Notes:: PolyView

	SPH	CYL	AX	ADD
OD	-4
OS	-4.5

Date of visit:: 12/28/2024 4:38:00 PM
Cost:: 4
Service:: Polyview 1 Lens
prescribed by doctor:: OLD Rx
Notes:: we gave her -4.25 for OD ONLY

	SPH	CYL	AX	ADD
OD	-4.25
OS

Date of visit:: 12/28/2024 4:38:00 PM
Cost:: 4
Service:: Polyview 1 Lens
prescribed by doctor:: OLD Rx
Notes:: we gave her -4.25 for OD ONLY

	SPH	CYL	AX	ADD
OD	-4.25
OS

Date of visit:: 3/27/2025 4:50:00 PM
Cost:: 8
Service:: Contact Lenses
prescribed by doctor:: Dr.Moussa Choeib
Notes:: PolyView

	SPH	CYL	AX	ADD
OD	-4.25
OS	-4.5

Date of visit:: 5/3/2025 3:26:00 PM
Cost:: 8
Service:: Contact Lenses
prescribed by doctor:: Dr.Moussa Choeib
Notes:: POLYVIEW

	SPH	CYL	AX	ADD
OD	-4.25
OS	-4.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS