New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/17/2025 4:38:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Dr. Mariam Iskandar
Notes:: AR Transition, metal bronze

	SPH	CYL	AX	ADD
OD	0.75	-0.25	40
OS	0.5	-0.75	165

Date of visit:: 1/17/2025 4:41:00 PM
Cost:: 30
Service:: Change lenses
prescribed by doctor:: Dr. Mariam Iskandar
Notes:: AR

	SPH	CYL	AX	ADD
OD	0.75	-0.25	40
OS	0.5	-0.75	165

Date of visit:: 1/17/2025 4:41:00 PM
Cost:: 30
Service:: Change lenses
prescribed by doctor:: Dr. Mariam Iskandar
Notes:: AR

	SPH	CYL	AX	ADD
OD	0.75	-0.25	40
OS	0.5	-0.75	165

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS