New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/23/2024 1:09:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hassan Chahine
Notes:: Transition AR

	SPH	CYL	AX	ADD
OD	-0.25	1	175
OS	-0.75	1.5	5

Date of visit:: 7/15/2026 3:11:00 PM
Cost:: 20
Service:: Change Lenses
prescribed by doctor:: Old Rx
Notes:: Transition AR

	SPH	CYL	AX	ADD
OD	-0.25	1	175
OS	-0.75	1.5	5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS