New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:
Cost:: 60
Service:: Transition
prescribed by doctor:
Notes:: 60

	SPH	CYL	AX	ADD
OD		-0.5	50
OS	-0.75	-0.25	155

Date of visit:: 12/12/2024 4:53:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Dr.Hussein Alameh
Notes:: AR

	SPH	CYL	AX	ADD
OD		-2	35
OS	-0.75

Date of visit:: 6/4/2026 4:45:00 PM
Cost:: 40
Service:: Change Lenses
prescribed by doctor:: Nancy
Notes:: AR transition W9

	SPH	CYL	AX	ADD
OD	0	-1	38
OS	0	-0.5	162

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS