New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/24/2025 4:04:00 PM
Cost:
0
Service:
Frame + Lenses
prescribed by doctor:
Dr. Hussein Alame
Notes:
Metal + AR Lenses
SPH
CYL
AX
ADD
OD
1.5
-0.5
90
OS
1.5
-0.5
61
Date of visit:
7/9/2026 2:51:00 PM
Cost:
0
Service:
Frame+Lenses
prescribed by doctor:
Old RX
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
1.5
-0.5
90
OS
1.5
-0.5
61
Date of visit:
6/2/2026 5:11:00 PM
Cost:
0
Service:
Frame+Lenses
prescribed by doctor:
Luna
Notes:
AR for near
SPH
CYL
AX
ADD
OD
1.5
-0.5
100
1.75
OS
2
-0.5
60
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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