New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/19/2024 2:00:00 PM
Cost:: 50
Service:: Change Lenses
prescribed by doctor:: Dr. Mustapha Daher
Notes:: Transition AR (Dr. Mostapha referred her and her brother here)

	SPH	CYL	AX	ADD
OD	4	-4	10
OS	4	-3.5	175

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS