New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/14/2024 9:56:00 AM
Cost:
135
Service:
Frame + Lenses
prescribed by doctor:
Aya
Notes:
Di Monti Frame+infinity FMC + montage
SPH
CYL
AX
ADD
OD
3.5
-0.75
90
2
OS
3.5
-0.75
80
2
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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