New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/16/2024 5:54:00 PM
Cost:: 40
Service:: Change Lenses
prescribed by doctor:: Dr. Ali Reda Haj Hassan
Notes:: AR Lenses

	SPH	CYL	AX	ADD
OD	-0.5
OS	-0.5

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS