New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/15/2025 2:48:00 PM
Cost:: 30
Service:: Frame + Lenses
prescribed by doctor:: dr. Ali Alhaj
Notes:: lucci, antiblue green coated

	SPH	CYL	AX	ADD
OD	0	-0.5	10
OS	-0.25	-0.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS