+--------------------------------------------------------+--------------------+
| ______________________________________________________ |   Numero: ______.  |
| CADASTRO DE RECEITA MEDICA                             |                    |
+--------------------------------------------------------+--------------------+
|  Cliente.: ____. - ________________________________________________________ |
|  Endereco: ________________________________________________________________ |
|  Bairro..: ________________________________________________________________ |
|  CEP.....: __________   Cidade.: _______________________________ Estado: __ |
|  CPF.....: ________________ RG.: ______________    Fone: _______________    |
+--------------------------------------+--------------------------------------+
| OLHO DIREITO                         | OLHO ESQUERDO                        |
| ------------                         | -------------                        |
| Esferico.: ___.__  Cilindro.: ___.__ | Esferico.: ___.__  Cilindro.: ___.__ |
| Adicao...: ___.__  D.N.P....: ___.__ | Adicao...: ___.__  D.N.P....: ___.__ |
| Eixo.....: ___.__  Altura...: ___.__ | Eixo.....: ___.__  Altura...: ___.__ |
+--------------------------------------+--------------------------------------+
|  Armacao.: _________________________   Lente.: __________________________   |
+-----------------------------------------------------------------------------+
| Data Consulta.: __/__/____  Medico..: _____________________________________ |
| Data Cadastro.: __/__/____                                                  |
| Observacao: _______________________________________________________________ |
|  __________________________________________________________________________ |
+-----------------------------------------------------------------------------+
| ____________________________________________________________________________|
+---------------------------------------------------- PANORAMA Sistemas Ltda -+