New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/26/2024 5:55:00 PM
Cost:: 20
Service:: Toric PolyView
prescribed by doctor:: Dr. Jamal Bleik
Notes:

	SPH	CYL	AX	ADD
OD	4	-2.25	180
OS	4	-2.25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS