New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/9/2024 3:44:00 PM
Cost:
90
Service:
2 Frame + 2 Lenses
prescribed by doctor:
Dr. Ali Shokor
Notes:
2 Frames + 2 Lenses (one reading + one distance)
SPH
CYL
AX
ADD
OD
1.5
-0.5
85
2.25
OS
1.75
-0.75
95
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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