New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/10/2024 5:50:00 PM
Cost:: 120
Service:: Frame + Lenses
prescribed by doctor:: Dr. Sabrina Rammal
Notes:: AR Lenses "Kawthrani"

	SPH	CYL	AX	ADD
OD	-1.25	-4	30
OS	-4.5	-4.5	135

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS