New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/15/2025 10:36:00 AM
Cost:: 100
Service:: AR
prescribed by doctor:: Dr. Jamal Bleik
Notes:: swing frame , AR LENSES , ESOTROPIC PATIENT

	SPH	CYL	AX	ADD
OD	4.5
OS	4.5

Date of visit:: 10/28/2025 2:59:00 PM
Cost:: 100
Service:: Frame+Lenses
prescribed by doctor:: dr. Jamal bleik
Notes:: Ar 60mm

	SPH	CYL	AX	ADD
OD	4.5
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