New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 1/20/2025 1:01:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: dr. Hassan Salam
Notes:: AR

	SPH	CYL	AX	ADD
OD	-2.25	-2	180
OS	-1.75	-2	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS