New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/26/2024 12:46:00 PM
Cost:
70
Service:
Frame + Lenses
prescribed by doctor:
Dr. Moussa Shoueib
Notes:
Airlite + AR Lenses 1.67
SPH
CYL
AX
ADD
OD
-3
-0.5
45
OS
-5.5
-0.5
140
Date of visit:
5/31/2024 2:58:00 PM
Cost:
120
Service:
Frame + Lenses
prescribed by doctor:
Old Rx
Notes:
Airlite + AR Lenses + Transition 1.67
SPH
CYL
AX
ADD
OD
-3
-0.5
45
OS
-5.5
-0.5
140
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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