New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/13/2024 12:24:00 PM
Cost:: 80
Service:: Airlite + lenses Ar
prescribed by doctor:: Dr. Mohammad Al Haj ali
Notes:

	SPH	CYL	AX	ADD
OD		1.25	85
OS		1.25	85

Date of visit:: 1/9/2025 12:02:00 PM
Cost:: 80
Service:: Frame+Lenses
prescribed by doctor:: DR. Ali Alhaj
Notes:: antiblue lenses green coated with Airlite frame

	SPH	CYL	AX	ADD
OD	0	1.25	85
OS	0	1.25	85

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS