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Annie Jacobs's Application for Admittance to JCRS, 1909 January 29

 Item
Identifier: B002.01.0101.0015.00001

Overview

Application for admittance to JCRS filled out by hand in ink for Annie Jacobs. Information on the form includes her age, birth place, occupation, residence, marital status, children's ages, membership to Beneficial Societies and lodges, nearest relatives, and signed by Annie Jacobs. At the bottom of the page is a section entitled "Recommendation" is left blank. The back of the form has section entitled "Report of Medical Examiner," which states that the examination was made January 29, 1909 and informs that the patient suffers from stage 2 tuberculosis. Also has remarks that read "involvement of both [illegible]" and is signed by C.D. Spivak. The middle section of the back is a form filled out by hand in ink. It reads "Application No.1025, Case No.721, Application of Anna Jacobs, Address 1471 Knox Court, Received Jan 29 1909, Accepted Mar 20 1909, Admitted Mar 22 1909, Discharged Aug 9 1909." The bottom of the page reads "Admission and Dismission Committee" which is blank.

Dates

  • 1909 January 29

Creator

Conditions Governing Use

Copyright restrictions may apply. User is responsible for all copyright compliance.

Extent

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.

General

Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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