New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/17/2024 6:44:00 PM
Cost:: 110
Service:: Frame + Lenses
prescribed by doctor:: Dr. Fouad Khreiss
Notes:: Anti-Blue + Transition W9 + Semi Rimless

	SPH	CYL	AX	ADD
OD	-4	-0.5	130
OS	-3.75

Date of visit:: 6/11/2024 6:20:00 PM
Cost:: 0
Service:: Frame + Lenses
prescribed by doctor:: Dr. Fouad Khreiss
Notes:: W9 + AR

	SPH	CYL	AX	ADD
OD	-4	-0.5	31
OS	-3.75

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS