New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/6/2024 10:44:00 AM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hussein Alame
Notes:: PD : R:30 , L:27

	SPH	CYL	AX	ADD
OD	1.25
OS	1.25

Date of visit:: 11/30/2024 10:49:00 AM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hussein Alame
Notes:: PD : R:30 , L:27

	SPH	CYL	AX	ADD
OD	1.5
OS	1.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS