New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 9/16/2024 1:04:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Aya
Notes:: Airlite + AR Lenses

	SPH	CYL	AX	ADD
OD		-1	175
OS		-0.75	6

Date of visit:: 7/28/2026 2:11:00 PM
Cost:: 100
Service:: Change lenses
prescribed by doctor:: Dr. Hussein Hazimeh
Notes:: Antiblue transition

	SPH	CYL	AX	ADD
OD		-4	180
OS		-2.5	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS