New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/17/2024 12:55:00 PM
Cost:: 40
Service:: Change Lenses
prescribed by doctor:: Dr. Hassan Chahine
Notes:: Transition AR W9

	SPH	CYL	AX	ADD
OD	-0.5	-3	180
OS	-1	-2.25	170

Date of visit:: 1/13/2025 12:18:00 PM
Cost:: 35
Service:: change lenses
prescribed by doctor:: by dr. no name
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-0.75	-3	180
OS	-1	-2.25	170

Date of visit:: 1/13/2025 12:18:00 PM
Cost:: 100
Service:: Frame+Lenses
prescribed by doctor:: by dr. no name
Notes:: AR TRANSITION + NEW FRAME

	SPH	CYL	AX	ADD
OD	-0.75	-3	180
OS	-1	-2.25	170

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS