New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/11/2024 4:39:00 PM
Cost:
130
Service:
2 Frames + 2 Lenses (Airlite)
prescribed by doctor:
Aya
Notes:
One Anti-Blue and One Transition W9
SPH
CYL
AX
ADD
OD
0.5
-0.75
100
OS
-0.5
Date of visit:
6/10/2025 4:47:00 PM
Cost:
30
Service:
change lenses
prescribed by doctor:
OLD Rx
Notes:
AR transition(this price is because according to warranity)
SPH
CYL
AX
ADD
OD
0.5
-0.75
100
OS
-0.5
Date of visit:
6/10/2025 4:47:00 PM
Cost:
30
Service:
change lenses
prescribed by doctor:
OLD Rx
Notes:
AR transition(this price is because according to warranity)
SPH
CYL
AX
ADD
OD
0.5
-0.75
100
OS
-0.5
Date of visit:
6/10/2025 4:47:00 PM
Cost:
30
Service:
change lenses
prescribed by doctor:
OLD Rx
Notes:
AR transition(this price is because according to warranity)
SPH
CYL
AX
ADD
OD
0.5
-0.75
100
OS
-0.5
Date of visit:
6/10/2025 4:47:00 PM
Cost:
30
Service:
change lenses
prescribed by doctor:
OLD Rx
Notes:
AR transition(this price is because according to warranity)
SPH
CYL
AX
ADD
OD
0.5
-0.75
100
OS
-0.5
Date of visit:
6/10/2025 4:47:00 PM
Cost:
120
Service:
change lenses , frame +lenses
prescribed by doctor:
OLD Rx
Notes:
both AR transition(this price is because according to warranity)the frame with lenses is airlite frame
SPH
CYL
AX
ADD
OD
0.5
-0.75
100
OS
-0.5
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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