New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
11/18/2025 12:27:00 PM
Cost:
70
Service:
Frame + Lenses
prescribed by doctor:
Dr. Hassan Salam
Notes:
AR
SPH
CYL
AX
ADD
OD
1.25
-0.75
5
OS
1.25
-1.25
165
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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