| Label | Referral Details |
|---|---|
| Full Name | test |
| testing@gmail.com | |
| Phone | +919856235852 |
| Address line 1 | #443.bvcbcbcv |
| Postcode | 140302 |
| Gender | Male |
| Date of birth | 10/15/2024 |
| Condition details | Oculoplastic |
| File | Oculoplastic |
| Eye Emergency | |
| Left Eye | [left_eye] |
| Right Eye | [right_eye_field] |
| Right Eye Comments | |
| Left Eye Comments | |
| Uploaded document | [uploaded_document] |
| Details |
