New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
9/9/2025 3:42:00 PM
Cost:
75
Service:
Frame + bifocal lenses
prescribed by doctor:
Dr. Hassan Moussa Bassam
Notes:
Penelope Frame + Bifocals
SPH
CYL
AX
ADD
OD
0.75
1
170
2
OS
1.5
1
5
2
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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