New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/16/2025 10:41:00 AM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: dr. HUSSEIN HAZIMEH
Notes:: Airlite frame+ AR TRANSITION HIGH INDEX

	SPH	CYL	AX	ADD
OD		-3	20
OS		-3	160

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS