New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 4/26/2024 5:56:00 PM
Cost:: 110
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hassan Chahine
Notes:: Airlite + AR Lenses + Compact IDOL

	SPH	CYL	AX	ADD
OD	3.5	-6	15
OS	4.25	-6	165

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS