New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/19/2024 1:52:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Dr. Mustapha Daher
Notes:: Airlite + AR Lenses Transtion

	SPH	CYL	AX	ADD
OD	4	-3.5	170
OS	3	-3	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS