New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/23/2024 11:50:00 AM
Cost:
150
Service:
Change Lenses
prescribed by doctor:
Dr. Hassan Chahine
Notes:
One Polarized 90$ + One Same Color 50$ Idol
SPH
CYL
AX
ADD
OD
1.75
90
OS
1.75
95
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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