Max Glick's First Application for Admittance to JCRS, 1908 November 19

Ripped JCRS Application for Admittance filled out in ink for Patient #969 M. Glick "[t]o the Executive Committee of the Jewish Consumptives' Relief Society, Denver, Colorado" dated "November 19th 1908" [sic]. The application includes patient's name, age, place of birth, citizenship, occupation, residential information, medical information, marital status, number and ages of children, and nearest relatives or friends; "(wife) Annie Glick 1214 F'Klin St. Pittsburg PA (father) Henry Glick 514 - 4[th] Av Homestead PA," and the application is signed by Max Glick. The bottom third of the application has been ripped off. The back of the application reads, "REPORT OF MEDICAL EXAMINEER Date Nov 19-1908...Stage II Remarks Left lung involved both lobes" and this section is signed "Hilkowitz" [sic]. The back-middle section of the application reads, "Application No. 969 Case No. 665 APPLICATION OF Max Glick Address 49 S. Sherman St. Received Nov. 19 1908, Accepted Dec. 1 1908, Admitted Dec. 3 1908, Discharged April 15 1909" [sic].