New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/13/2024 4:10:00 PM
Cost:
120
Service:
2 Frames + 2 Lenses (Airlite)
prescribed by doctor:
Dr. Mohammad Assaf
Notes:
For Far Transition W9 + For Near Anti-Blue
SPH
CYL
AX
ADD
OD
-1
-1.25
125
1.5
OS
-0.75
-1.75
53
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
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