New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/2/2025 7:02:00 PM
Cost:: 35
Service:: Change Lenses
prescribed by doctor:: Dr. Hassan Sallam
Notes:: AR

	SPH	CYL	AX	ADD
OD		-0.75	180
OS	-2.25	-0.75	165

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS