New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/11/2025 3:19:00 PM
Cost:
100
Service:
Frame + Lenses
prescribed by doctor:
dr. Riad A. Bejjani
Notes:
marina s frame bifocal lenses
SPH
CYL
AX
ADD
OD
1.5
0.5
165
2.5
OS
1.25
0.5
5
2.5
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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