New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/23/2025 2:41:00 PM
Cost:
110
Service:
2 Frame + 2 Lenses
prescribed by doctor:
Dr. Hassan Salam
Notes:
Sketchers Frame + AR Lenses + Trans for Dist and Frame + AR Lenses for Near
SPH
CYL
AX
ADD
OD
0.5
0.5
OS
0.5
0.5
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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