New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/15/2024 6:10:00 PM
Cost:: 85
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hasan Salam
Notes:: Flex Frame + Transition AR W9

	SPH	CYL	AX	ADD
OD	-1.75	-1.25	175
OS	-1.75	-1.25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS