New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/22/2024 3:21:00 PM
Cost:: 100
Service:: 2 Frame + 2 Lenses
prescribed by doctor:: Aya
Notes:: (1st Frame = 30$ -->AR) (2nd Frame =70$ --> Transition)

	SPH	CYL	AX	ADD
OD	-0.5	-0.5	170
OS	-0.25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS