New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
3/30/2024 5:18:00 PM
Cost:
150
Service:
Frame + Lenses
prescribed by doctor:
Dr. Hasan Salam
Notes:
TOM FORD Titanium + AR + Transition
SPH
CYL
AX
ADD
OD
3.5
-1.75
180
OS
3
-0.75
175
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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