New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
12/1/2025 1:45:00 PM
Cost:
40
Service:
Frame + Lenses
prescribed by doctor:
Dr. Hasan Salam
Notes:
AR Lenses
SPH
CYL
AX
ADD
OD
0.25
OS
0.5
-1
5
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
Back to List