New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/2/2024 3:32:00 PM
Cost:: 75
Service:: Airlite + Lenses
prescribed by doctor:: Alexander Assi
Notes:: Compact AR

	SPH	CYL	AX	ADD
OD	-3.5	-0.75	130
OS	-3.5	-0.5	40

Date of visit:: 9/12/2025 4:47:00 PM
Cost:: 100
Service:: Frame+Lenses
prescribed by doctor:: Dr. Ali Alhakim
Notes:: AR 1.61

	SPH	CYL	AX	ADD
OD	-5.5	-0.5	150
OS	-5.5	-0.5	30

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS