A. Richman's Application for Admittance to JCRS, 1908 December 29
Application for admittance to JCRS filled out by hand in ink by A. Richman. Information on the form includes his age, birthplace, occupation, residence, marital status, children's ages, membership to beneficial societies and lodges, nearest relatives, and signed by A. Richman. At the bottom of the page, under "Recommendation," are two names and addresses. The first reads "Name [illegible] Reichman, Address 3241 Canejos Pl." The second reads "Name J Cohen, Address 1424 Irving St." The back of the form has a section entitled "Report of Medical Examiner," which states that the examination took place December 30 1908 and found the patient to be in the third stage of the disease, "both lungs involved. Cavity signs on left side" and is signed by A. Zederbaum. The middle section of the back form is filled out by hand in ink. It reads "Application No.1002, Case No.690, Application of A. Richman, Address 3241 Canejos St, 2537 Curtis, Received Dec 29 1908, Accepted Feb 3 1909, Admitted Feb 3 1909, Died Apr 8 1909." The bottom of the back of the application reads "Admission and Dismission Committee" which was left blank.
- 1908 December 29
- Jewish Consumptives' Relief Society (U.S.) (Producer, Organization)
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1 items (application)
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.
Physical Characteristics and Technical Requirements
At the top and again at the bottom of the middle section of the back of the form, the word "EMERGENCY" is stamped in blue ink.
Title is supplied by archivist.