New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/20/2025 11:33:00 AM
Cost:
50
Service:
Frame + Lenses
prescribed by doctor:
Dr. Abass Baydoun
Notes:
AR, Airlite frame
SPH
CYL
AX
ADD
OD
1
0.75
95
OS
1
0.75
85
Date of visit:
2/5/2026 2:17:00 PM
Cost:
25
Service:
change lenses
prescribed by doctor:
Old RX
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
1
0.75
95
OS
1
0.75
85
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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