New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/26/2024 3:21:00 PM
Cost:
120
Service:
Frame + Lenses
prescribed by doctor:
Aya
Notes:
Airlite + US Desgin FMC Lenses
SPH
CYL
AX
ADD
OD
0.75
-0.75
90
1.75
OS
1
-1
80
1.75
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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