New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:
Cost:: 22
Service:
prescribed by doctor:
Notes:

	SPH	CYL	AX	ADD
OD	-5.25	1.25	105
OS	-5.5	1.75	80

Date of visit:: 2/18/2026 3:24:00 PM
Cost:: 140
Service:: Frame+Lenses
prescribed by doctor:: Dr. Hassan Chahine
Notes:: AR1.74

	SPH	CYL	AX	ADD
OD	-5.25	1.25	105
OS	-5.5	1.75	80

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS