New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 2/20/2025 11:39:00 AM
Cost:: 75
Service:: Frame + Lenses
prescribed by doctor:: dr. Hassan Hazimeh
Notes:: Flex ,AR

	SPH	CYL	AX	ADD
OD	-1.5	-2.75	30
OS	-1.5	-2.5	150

Date of visit:: 3/24/2025 12:31:00 PM
Cost:: 25
Service:: Contact Lenses
prescribed by doctor:: Dr. Hussein Hazimeh
Notes:: Toric Contact Lenses

	SPH	CYL	AX	ADD
OD	-1.5	-2.75	30
OS	-1.5	-2.5	150

Date of visit:: 3/27/2025 6:21:00 PM
Cost:: 25
Service:: Contact Lenses
prescribed by doctor:: Old Rx
Notes:: Toric CL By SAAD

	SPH	CYL	AX	ADD
OD	-1.5	-2.75	30
OS	-1.5	-2.5	150

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS