The Aloha Beaded Medical ID Bracelet has that beachy casual feel. Puka shells are the primary beads which are accompanied by a single pink accent shell and sterling silver spacer beads. This puka shell bracelet is the perfect partner for jeans and beachwear! All N-Style ID beaded medical bracelets should be removed before showering or water activities and are not recommended for everyday wear. For everyday wear, we recommend switching the beaded bracelet to the discounted stainless steel chain bracelet or one of our other stainless steel chain bracelets Charms pictured are sold separately and will come attached to the ID tag.