New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/1/2024 4:45:00 PM
Cost:: 2400000
Service:: 2 frames + 2 lenses
prescribed by doctor:: Dr. Ali Shokor
Notes:: AR Lenses (NEAR + FAR)

	SPH	CYL	AX	ADD
OD	0.5			1.5
OS	0.75	-0.25	120	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