New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/20/2024 3:38:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Dr. Mohamad Abady
Notes:: Airlite + AR Lenses

	SPH	CYL	AX	ADD
OD		-0.5	15
OS		-0.5	180

Date of visit:: 9/11/2025 3:32:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: OLD RX
Notes:: Airlite + AR Lenses

	SPH	CYL	AX	ADD
OD		-0.5	15
OS		-0.5	180

Date of visit:: 9/12/2025 4:52:00 PM
Cost:: 10
Service:: Frame + Lenses
prescribed by doctor:: Old Rx
Notes:: AR

	SPH	CYL	AX	ADD
OD
OS	0	-0.5	180

Date of visit:: 7/24/2026 1:04:00 PM
Cost:: 35
Service:: Change Lenses
prescribed by doctor:: Dr. Ali Shoker
Notes:: AR

	SPH	CYL	AX	ADD
OD	0	-0.5	13
OS	0	-1	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS