New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/3/2025 11:32:00 AM
Cost:
280
Service:
Frame + Lenses
prescribed by doctor:
Dr. Mostapha Daher
Notes:
progressive lenses, US design transition + montage
SPH
CYL
AX
ADD
OD
1.25
-1.25
75
2
OS
1.25
-1.25
80
2
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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