New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/5/2024 12:23:00 PM
Cost:
200
Service:
Frame + Lenses
prescribed by doctor:
Dr. Randa Haddad
Notes:
Infinity FMC transition + Di Monti Frame
SPH
CYL
AX
ADD
OD
0.5
-0.5
40
2.5
OS
0.5
-0.5
60
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
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