New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 6/4/2025 12:10:00 PM
Cost:: 80
Service:: Change Lenses
prescribed by doctor:: Hussein Alameh
Notes:: old raybun frame+Pro ortive X same color with logo (raybun) omar put the logo idol cut

	SPH	CYL	AX	ADD
OD	1.5	1	170
OS	1	1	25

Date of visit:: 6/4/2025 12:52:00 PM
Cost:: 140
Service:: Frame+Lenses
prescribed by doctor:: Dr. Hussein Alame
Notes:: 2 glasses (one glass idol cut pro-ortive X same color with logo raybun),+1 new frame AR lenses for near

	SPH	CYL	AX	ADD
OD	1.5	1	170	2.25
OS	1	1	25	2.25

Date of visit:: 5/10/2025 4:46:00 PM
Cost:: 40
Service:: Frame+Lenses
prescribed by doctor:: hussein alameh
Notes:: AR

	SPH	CYL	AX	ADD
OD	1.5	1	170
OS	1	1	25

Date of visit:: 5/10/2025 4:46:00 PM
Cost:: 40
Service:: Frame+Lenses
prescribed by doctor:: hussein alameh
Notes:: AR

	SPH	CYL	AX	ADD
OD	1.5	1	170
OS	1	1	25

Date of visit:: 5/9/2025 4:46:00 PM
Cost:: 75
Service:: Frame+Lenses
prescribed by doctor:: hussein alameh
Notes:: AR transition,

	SPH	CYL	AX	ADD
OD	1.5	1	170
OS	1	1	25

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS