New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/3/2024 4:29:00 PM
Cost:: 190
Service:: Frame for far + Frame for near
prescribed by doctor:: Dr. Sabrina Rammal + Aya Changed
Notes:: AR + transition for FAR + AR for near

	SPH	CYL	AX	ADD
OD	1.25			2
OS	0.5			2

Date of visit:: 7/3/2026 11:58:00 AM
Cost:: 70
Service:: Frame+Lenses
prescribed by doctor:: Old Rx
Notes:: AR

	SPH	CYL	AX	ADD
OD	3.25
OS	2.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS