New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/2/2025 11:06:00 AM
Cost:
110
Service:
Frame + Lenses
prescribed by doctor:
Dr. Amal Amrou
Notes:
AR For BOTH , tifany and co telween shamse + sunglasses
SPH
CYL
AX
ADD
OD
-1.75
-0.75
80
OS
-1.75
-0.75
60
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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