New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/15/2024 4:10:00 PM
Cost:: 30
Service:: Change Lenses
prescribed by doctor:: Dr. Ali Abed Al Hajj
Notes:: AR Lenses + Compact

	SPH	CYL	AX	ADD
OD	-1.25	-2.5	175
OS	-1.25	-2.5	5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS