New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 3/22/2024 2:19:00 PM
Cost:: 35
Service:: Frame + Transtion Lenses AR
prescribed by doctor:: Dr. Ali Reda Haj Hassan
Notes:: He took this frame depending on sale 50% mothers day post

	SPH	CYL	AX	ADD
OD	0.5	-0.5	165
OS	0.25	-2	10

Date of visit:: 5/31/2024 3:03:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Old Rx
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	0.5	-0.5	165
OS	0.25	-2	10

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS