New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/8/2025 12:03:00 PM
Cost:
120
Service:
Frame + Lenses
prescribed by doctor:
Dr. Hassan Chahine
Notes:
max and co, metalic frame AR transition W9
SPH
CYL
AX
ADD
OD
2
1
170
2.5
OS
1.5
1
160
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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