New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/9/2024 1:29:00 PM
Cost:
20
Service:
Change Lenses
prescribed by doctor:
Dr. Ahmad Mansour
Notes:
Changed ONE lens ONLY Right One (IDOL Bifocal)
SPH
CYL
AX
ADD
OD
2
0.5
143
2.25
OS
1.75
0.75
16
2.25
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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