New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/30/2024 1:19:00 PM
Cost:: 130
Service:: Frame + Lenses
prescribed by doctor:: Dr. Ali Hajj
Notes:: Oliver Peoples Frame + Transition + AR W9

	SPH	CYL	AX	ADD
OD	0	-0.75	180
OS	0	-1	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS