New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/17/2024 5:58:00 PM
Cost:: 70
Service:: 2 Frames + 2 Lenses
prescribed by doctor:: Dr. Abbas Baydoun
Notes:: One Distance One Near

	SPH	CYL	AX	ADD
OD	0	2.25	175	2.5
OS	0	1.5	175	2.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS