Adjustable medical punch handles punched two, three, five and seven holes for special medical forms. Punch drills 11/32" holes in up to 40 sheets at a time. Design includes an adjustable paper guide and large-capacity chip tray. Adjustable medical punch comes with five punch heads and accepts seven. Punch is made from heavy-gauge steel.Adjustable medical punch handles punched two, three, five and seven holes for special medical forms. Punch drills 11/32" holes in up to 40 sheets at a time. Design includes an adjustable paper guide and large-capacity chip tray. Adjustable medical punch comes with five punch heads and accepts seven. Punch is made from heavy-gauge steel.