New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
4/17/2025 2:56:00 PM
Cost:
250
Service:
Frame + Lenses
prescribed by doctor:
Dr. Hassan Salam
Notes:
GINO VEGA FRAME + Infinity pro + IDOL MONTAGE
SPH
CYL
AX
ADD
OD
2
2.25
OS
2.75
2.25
Date of visit:
4/25/2025 12:22:00 PM
Cost:
0
Service:
Frame+Lenses
prescribed by doctor:
dr. Hassan salam
Notes:
f0r near , dxyoo AR
SPH
CYL
AX
ADD
OD
2
2.25
OS
2.75
2.25
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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