New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/21/2024 6:16:00 PM
Cost:
65
Service:
1 Frame + Lenses + 2 pairs of lenses --> for near
prescribed by doctor:
Dr. Mohammad Assaf
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
0.5
1.5
95
2.75
OS
0.75
0.5
40
2.75
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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