New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/7/2024 5:50:00 PM
Cost:: 250
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: Infinity FMC Transition progressive

	SPH	CYL	AX	ADD
OD	0.75			1.25
OS	0.75			1.25

Date of visit:: 8/8/2024 3:08:00 PM
Cost:: 0
Service:: change lenses Freeform Transtion
prescribed by doctor:: Hussien
Notes:

	SPH	CYL	AX	ADD
OD				1.5
OS				1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS