New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/25/2024 4:27:00 PM
Cost:
30
Service:
Frame + Lenses
prescribed by doctor:
Dr. Mohammad Assaf
Notes:
Airlite + Anti- Blue Lenses
SPH
CYL
AX
ADD
OD
0.5
176
2.5
OS
0.5
20
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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