New Visit
patient
Patient Name:
Phone number:
PD of patient:
visits:
Date of visit:
7/17/2024 5:01:00 PM
Cost:
74
Service:
1 Airlite + Lenses and another pair of lenses
prescribed by doctor:
Dr. Hassan Chahine
Notes:
For Near ONLY
SPH
CYL
AX
ADD
OD
2.25
0.5
20
OS
2.25
0.5
10
New visit Information
Date of visit:
Cost in this visit:
type of service:
prescribed by doctor
Note:
SPH
CYL
AX
ADD
OD
OS
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