New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/6/2024 6:59:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hussein Hazmieh
Notes:: AR Lenses 1.61

	SPH	CYL	AX	ADD
OD	-2.5	-1.25	165
OS	-2.5	-0.75	175

Date of visit:: 9/22/2025 3:22:00 PM
Cost:: 40
Service:: Change Lenses
prescribed by doctor:: Dr. Hussein Hazimeh
Notes:: AR lenses 1.61

	SPH	CYL	AX	ADD
OD	-3	-1	170
OS	-3	-1	5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS