New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/21/2024 1:36:00 PM
Cost:: 30
Service:: Change Lenses
prescribed by doctor:: Dr. Mohamad Assaf
Notes:: AR Lenses 1.61

	SPH	CYL	AX	ADD
OD	-6
OS	-6

Date of visit:: 9/7/2024 1:01:00 PM
Cost:: 8
Service:: polyview
prescribed by doctor:: Old RX
Notes:: she takes CL every month aprox

	SPH	CYL	AX	ADD
OD	-6
OS	-6

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS