New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/3/2025 4:39:00 PM
Cost:: 20
Service:: Change lenses
prescribed by doctor:: Dr. Ali Alhaj
Notes:: AR old frame change lenses for far

	SPH	CYL	AX	ADD
OD	0.75	1.25	180
OS	0	1.5	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS