Thank you for viewing. Please purchase only if you understand that this is a used item and has been stored at home. There are some minor scratches and stains from removing the supplements (please check the second photo). There are no holes, and it has not been cut. Petit Nurse Removable Supplement Case Studies: Assessment Using Gordon's Framework Nursing Care Plans by Disease: Set of 20 Very useful during clinical practice. It's thin, so it's easy to copy. It will be shipped via Letter Pack Plus.