New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/6/2024 5:13:00 PM
Cost:: 80
Service:: 2 frames + 2 lenses
prescribed by doctor:: Dr. Moussa Shoueib
Notes:: One For Distance and One for Near

	SPH	CYL	AX	ADD
OD	4.25	-0.25	60	2.25
OS	4.25	-0.25	120	2.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS