Thank you for viewing! This is a handmade medical record book and health insurance card holder. The left side has a pocket for the medical record book and My Number card, and the right side has pockets for health insurance cards and prescriptions, which are separated for easy organization. It is made by dyeing vegetable-tanned leather and is entirely hand-stitched. Photo 3 shows what it looks like with a medical record book inside. Photo 6 shows the original leather scratches that appeared after dyeing; they are not stains. We appreciate your understanding that this is a handmade item before you purchase.