New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/23/2024 2:18:00 PM
Cost:
50
Service:
Change Lenses
prescribed by doctor:
Dr.Fouad Khriess
Notes:
Bifocal PRO Idol
SPH
CYL
AX
ADD
OD
3.5
-0.75
85
2.5
OS
3.75
-1.5
100
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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