New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/19/2024 6:15:00 PM
Cost:: 50
Service:: Change Lenses
prescribed by doctor:: Dr. Mahmmoud Jaroudi
Notes:: Compact AR

	SPH	CYL	AX	ADD
OD	-5.25	4.25	75
OS	-4.25	3	100

Date of visit:: 4/5/2025 2:47:00 PM
Cost:: 60
Service:: Frame+Lenses
prescribed by doctor:: Dr. Mosbah Bachir
Notes:: Nylor Frame + AR + 1.61

	SPH	CYL	AX	ADD
OD	-1	-4	170
OS	-1	-2.75	10

Date of visit:: 1/22/2026 12:22:00 PM
Cost:: 35
Service:: change lenses
prescribed by doctor:: Old RX
Notes:: AR

	SPH	CYL	AX	ADD
OD	-1	-4	170
OS	-1	-2.75	10

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS