New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/26/2024 5:45:00 PM
Cost:: 15
Service:: Lenses AR Only
prescribed by doctor:: Dr. Oussama Jibaai
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	1.25	-4	90
OS	0.75	-3.25	80

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS