New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/9/2025 5:02:00 PM
Cost:: 75
Service:: frame+lenses
prescribed by doctor:: DR. HUSSEIN ALAMEH
Notes:: Transition w9 AR

	SPH	CYL	AX	ADD
OD	-1.5	-0.25	120
OS	-1.25	-0.25	60

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS