New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/15/2024 5:06:00 PM
Cost:: 60
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hassan Chahine
Notes:: Transition AR

	SPH	CYL	AX	ADD
OD	-1.75	1.5	160
OS	0	1.5	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS