New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/27/2024 2:16:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: Dr. Oussama Jibaai
Notes:: Anti-Blue Green Coated (Back-Up Number 03935040)

	SPH	CYL	AX	ADD
OD	-2.25
OS	-1.25	-1	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS