New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/9/2024 12:36:00 PM
Cost:: 75
Service:: Frame + Lenses
prescribed by doctor:: Dr. Sabrina Rammal
Notes:: Airlite + AR Lenses

	SPH	CYL	AX	ADD
OD	0	-4	180
OS	0	-2	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS