New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/1/2024 4:23:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: BiFocal Transition

	SPH	CYL	AX	ADD
OD	0.5			2
OS	1			2

Date of visit:: 11/22/2025 2:00:00 PM
Cost:: 100
Service:: Frame+Lenses
prescribed by doctor:: Dr. Mohammad
Notes:

	SPH	CYL	AX	ADD
OD
OS

Date of visit:: 11/22/2025 2:00:00 PM
Cost:: 100
Service:: Frame+Lenses
prescribed by doctor:: Dr. Mohammad Khalife
Notes:: Bifocals +AR+ Transition

	SPH	CYL	AX	ADD
OD	1.25			1.75
OS	1.25			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