New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/20/2024 2:49:00 PM
Cost:
120
Service:
Frame + Lenses
prescribed by doctor:
Dr. Sabrina Rammal
Notes:
AR Lenses for Distance ONLY
SPH
CYL
AX
ADD
OD
-1.5
100
2.5
OS
-0.5
70
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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