New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
2/19/2026 3:02:00 PM
Cost:
125
Service:
Frame + Lenses
prescribed by doctor:
Dr. Hassan Salam
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
-0.25
-0.75
145
OS
-0.25
-1
25
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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