New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/22/2025 4:08:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: dr. hassan chahine
Notes:: AR

	SPH	CYL	AX	ADD
OD	-4.75	1.75	85
OS	-4.5	3.75	90

Date of visit:: 6/21/2025 6:20:00 PM
Cost:: 65
Service:: Frame + Lenses
prescribed by doctor:: OLD RX
Notes:: AR 60mm + Pink Frame

	SPH	CYL	AX	ADD
OD	-3	-1.75	175
OS	-0.75	-3.5	5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS