New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
5/30/2024 3:59:00 PM
Cost:
160
Service:
Airlite Frame + Lenses
prescribed by doctor:
Dr. George Mollayess
Notes:
Infinity FMC Transition progressive
SPH
CYL
AX
ADD
OD
4
2.5
OS
4
2.5
Date of visit:
6/5/2024 4:01:00 PM
Cost:
30
Service:
2 Pairs Of change lenses (Dist & Near)
prescribed by doctor:
Old Rx
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
4
2.5
OS
4
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
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