New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/21/2024 4:45:00 PM
Cost:
70
Service:
Frame + Lenses
prescribed by doctor:
Dr. Moussa Choeib
Notes:
ANTI-BLUE GREEN COATED (Airlite)
SPH
CYL
AX
ADD
OD
0
2.5
85
OS
0
1.25
95
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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