New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 12/23/2024 4:34:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hussein Alameh
Notes:: 1.67 AR Lenses

	SPH	CYL	AX	ADD
OD	-6	-2	180
OS	-5.5	-2.25	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS