New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/15/2025 2:51:00 PM
Cost:: 50
Service:: Frame + Lenses
prescribed by doctor:: Ali Abed Hussein El HAJ
Notes:: Airlite + AR Lenses

	SPH	CYL	AX	ADD
OD		1.5	100
OS		1	70

Date of visit:: 3/25/2025 3:20:00 PM
Cost:: 30
Service:: Contact Lenses
prescribed by doctor:: Dr. Christiane Al Haddad
Notes:: AR LENSES

	SPH	CYL	AX	ADD
OD		1.75	110
OS		1.75	80

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS