New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/29/2025 2:00:00 PM
Cost:
120
Service:
Change frame
prescribed by doctor:
OLD RX
Notes:
rimless frame , bel 2020 ken 3amil 3waynet ,lense special order made in france be 500 dollar
SPH
CYL
AX
ADD
OD
2
-2
76
2
OS
2
-2
88
2
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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