New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 5/20/2024 5:28:00 PM
Cost:: 40
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hussein Alame
Notes:: Airlite + AR Lenses

	SPH	CYL	AX	ADD
OD	2.5	1	3
OS	1	1.75	173

Date of visit:: 11/24/2024 4:20:00 PM
Cost:: 45
Service:: Frame+Lenses
prescribed by doctor:: luna
Notes:: Airlite+Lenses (Intermediate , distance only)

	SPH	CYL	AX	ADD
OD	2	1	3
OS	0.75	1.75	173

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS