New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
1/31/2026 5:00:00 PM
Cost:
230
Service:
Frame + Lenses
prescribed by doctor:
dr. Moussa Cheib
Notes:
progressive infinityAR + MONTAGE
SPH
CYL
AX
ADD
OD
1.5
0.5
70
1
OS
0.5
0.5
55
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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