New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 8/15/2025 3:37:00 PM
Cost:: 80
Service:: Frame + Lenses
prescribed by doctor:: dr. Ali Alhaj Hassan
Notes:: one new , one old but two change lenses AR

	SPH	CYL	AX	ADD
OD	1.25	-1.25	15	1
OS	1.25	-1.75	165	1

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS