New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/17/2024 12:59:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Dr. Moussa Shoueib
Notes:: Airlite + AR Lenses

	SPH	CYL	AX	ADD
OD	2.25	-3	5
OS	2.25	-3	175

Date of visit:: 7/20/2026 5:45:00 PM
Cost:: 50
Service:: Frame+Lenses
prescribed by doctor:: Dr. Moussa Choeib
Notes:: Antiblue clean

	SPH	CYL	AX	ADD
OD	1.75	-3	180
OS	1.75	-3	175

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS