New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/26/2024 6:08:00 PM
Cost:: 150
Service:: Frame + Lenses
prescribed by doctor:: Dr. Elias Jarade
Notes:: Anti-Blue Transition (px underwent CXL Sx Twice)

	SPH	CYL	AX	ADD
OD	-3	1.75	170
OS	-2.25	3	30

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS