Adolph Berman's Application for Admittance to JCRS, 1908 September 10

Item

Identifier: B002.01.0100.0058.00001

Staff Only

Overview

Application for admittance to JCRS filled out by hand in ink for Adolph Berman. Information on the form includes his age, birth place, occupation, residence, marital staus, child's age, nerest relatives, and signed by Adolph Berman. At the bottom of the page, under "Recommendation" has been left blank. The back of the form has a section entitled "Report of Medical Examiner" which states that the examination was made 9 months prior to filling out the application and signed by Hillkowitz. The middle section of the back is a form filled out by hand in ink. It reads "Application No 895, Case No 628, Adolph M. Berman, 1476 Hooker St, Received Sept 10 1908, Accepted Oct 1 1908, Admitted Oct 2 1908, Discharged Oct 18 1908". Underneath, handwritten in pencil reads "new disrally 9/14/08". The bottom of the page reads "Admission and Dismission Committe" which is blank.

Dates

1908 September 10

Creator

Jewish Consumptives' Relief Society (U.S.) (Producer, Organization)

Conditions Governing Use

Extent

1 items (application)

Additional Description

Scope and Contents

From the Series: This series of patient records includes medical reports and histories, statistical data of patients, x-rays, and death certificates. The patient files include applications, correspondence and some may also contain photographs and personal items.