New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/14/2025 11:59:00 AM
Cost:: 100
Service:: Frame + Lenses
prescribed by doctor:: dr. HassaN
Notes:: AR cylinder transition 1.61

	SPH	CYL	AX	ADD
OD	-5.5	-1	40
OS	-5.5	-1.5	150

Date of visit:: 9/7/2026 10:18:00 AM
Cost:: 130
Service:: Frame+Lenses
prescribed by doctor:: Dr. Ali Hakim
Notes:: 1.67 AR Transition

	SPH	CYL	AX	ADD
OD	-5.5	-1.25	50
OS	-5.5	-1.5	155

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS