New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/21/2025 4:57:00 PM
Cost:: 80
Service:: Frame+Lenses
prescribed by doctor:: Dr. Abass Baydoun
Notes:: Transition AR W9

	SPH	CYL	AX	ADD
OD	0	-3	175
OS	0	-3	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS