New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/31/2025 10:46:00 AM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Nancy
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-6	-0.75	50
OS	-6

Date of visit:: 2/28/2026 12:01:00 PM
Cost:: 60
Service:: Frame+Lenses
prescribed by doctor:: Dr. Moussa Shoeib
Notes:: AR Lenses 1.61 right eye

	SPH	CYL	AX	ADD
OD	-4	-0.75	140
OS	0	0.5	175

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS