New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 7/22/2024 6:06:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: Dr. Hussein Alame
Notes:: AR Lenses + Transition

	SPH	CYL	AX	ADD
OD	0.25	-2.75	173
OS	0.25	-2.25	162

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS