Alexander Stark's Application for Admittance to JCRS, 1909 October 4-1909 November 30

Item

Identifier: B002.01.0101.0139.00001

Staff Only

Overview

JCRS Application filled out by hand in ink for Alex Stark. Information on the form includes her age, birth place, occupation, residence, marital status, nearest relatives, and signed by Alex Stark. At the bottom of the page, under "Recommendation," are two names. Both are filled out in pencil and illegible. The back of a form has a section called "Report of Medical Examiner" which states that the examination was made one day prior to fillout the application. The middle section of the back is a form filled out by hand in ink. It reads "Application No. 1239, Case No 862. Alexander Stark, 1440 Knox Court, Received Oct 4 1909, Admitted Nov 1 1909, Died Nov 30 1909". The bottom of the page reads "Admission and Dismission Committee" which is blank.

Dates

1909 October 4-1909 November 30

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.