New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/27/2024 11:32:00 AM
Cost:: 50
Service:: metal frame + lenses
prescribed by doctor:: Aya
Notes:: AR Bifocal

	SPH	CYL	AX	ADD
OD	1			2.25
OS	1			2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS