New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/23/2024 5:44:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Dr. Moussa Shoueib
Notes:: Airlite + AR Lenses

	SPH	CYL	AX	ADD
OD	0	-0.75	175
OS	0.25	-1.5	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS