New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/15/2024 1:04:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:
Notes:: AR 60mm

	SPH	CYL	AX	ADD
OD	4.75	-1.5	180
OS	4	-1	10

Date of visit:: 6/27/2025 6:04:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Dr. Bassam Barakat
Notes:: Airlite Transparent 60 mm

	SPH	CYL	AX	ADD
OD	4.75	-1.5	170
OS	4.5	-1	5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS