New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
6/5/2025 1:26:00 PM
Cost:
60
Service:
Frame + Lenses
prescribed by doctor:
Dr. Moussa Shoueib
Notes:
AR
SPH
CYL
AX
ADD
OD
1
-1.5
15
OS
1
-2
170
Date of visit:
2/25/2026 1:15:00 PM
Cost:
60
Service:
Frame + Lenses
prescribed by doctor:
Dr. Moussa Shoeib
Notes:
AR
SPH
CYL
AX
ADD
OD
1.25
-1.5
15
OS
1.25
-2
170
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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