New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/20/2024 6:12:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Dr. Mohammad Assaf
Notes:: Airlite + AR Lenses + Transition

	SPH	CYL	AX	ADD
OD	1
OS	1.25	0.25	140

Date of visit:: 12/30/2024 3:10:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Rassoul Al Aazam
Notes:: Gave the frame for free paid for lenses ONLY

	SPH	CYL	AX	ADD
OD	-1
OS	-1

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS