New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/8/2025 12:33:00 PM
Cost:: 70
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hussein Hazimeh
Notes:: AR

	SPH	CYL	AX	ADD
OD	-1.25
OS	-1.25

Date of visit:: 2/20/2026 3:10:00 PM
Cost:: 50
Service:: change lenses
prescribed by doctor:: Dr. Hussein Hazimeh
Notes:: Antiblue green coated

	SPH	CYL	AX	ADD
OD	-2
OS	-2

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS