New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/23/2024 1:34:00 PM
Cost:
130
Service:
Frame + Lenses
prescribed by doctor:
Dr. Haj Hassan
Notes:
Emporio Armani Frame +US DESGIN Transition Lenses
SPH
CYL
AX
ADD
OD
1
-1
75
1.75
OS
1.75
-0.5
75
1.75
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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