New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/14/2024 10:01:00 AM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: Dr. Moussa Shoueib
Notes:

	SPH	CYL	AX	ADD
OD	1	2	80
OS		1.5	70

Date of visit:: 1/17/2025 1:33:00 PM
Cost:: 50
Service:: Frame+Lenses
prescribed by doctor:: Dr. Moussa Shoeib
Notes:: AR transition,

	SPH	CYL	AX	ADD
OD	1	2	90
OS	0	1.5	70

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS