New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/5/2024 11:15:00 AM
Cost:
180
Service:
Frame + Lenses
prescribed by doctor:
Aya
Notes:
Micheal Kors Frame+ Infinity FMC Progressive
SPH
CYL
AX
ADD
OD
1.5
2
OS
1.5
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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