New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/15/2024 5:07:00 PM
Cost:: 35
Service:: Change lenses AR
prescribed by doctor:: Dr. Ali Zorkot
Notes:: Anti-Blue Green Coated

	SPH	CYL	AX	ADD
OD	0	-2.25	180
OS	0	-2.25	170

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS