New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/19/2024 8:32:00 AM
Cost:
45
Service:
Frame + Lenses
prescribed by doctor:
Dr. Jamal Bleik
Notes:
Metal Frame+AR Lenses
SPH
CYL
AX
ADD
OD
0.5
1
90
OS
1
0.5
60
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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