New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/26/2025 3:04:00 PM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: dr. hussein Hazimeh
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	2.5	-3.75	180
OS	1.75	-2.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS