New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/25/2025 2:48:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Dr. Ali Alhakim
Notes:: Metal Frame + AR Lenses + Transition W9

	SPH	CYL	AX	ADD
OD	-0.25	-0.25	30
OS	-0.25	-0.25	165

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS