New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
11/22/2025 12:30:00 PM
Cost:
100
Service:
Frame + Lenses
prescribed by doctor:
Dr. Moussa Choeib
Notes:
Armad Basi Frame + AntiBlue Green Coated
SPH
CYL
AX
ADD
OD
-2
-0.25
180
OS
-1.5
-0.25
10
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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