New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/3/2025 4:58:00 PM
Cost:: 40
Service:: Frame +lenses
prescribed by doctor:: Dr. Moussa Choeib
Notes:: Metallic frame for far AR lenses

	SPH	CYL	AX	ADD
OD	0	1.25	175
OS	0	1.75	5

Date of visit:: 2/3/2025 5:03:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Dr. Moussa Choeib
Notes:: Metallic frame AR for near

	SPH	CYL	AX	ADD
OD	2.5	1	175
OS	2.5	1.5	5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS