Ben Belovsky's Application for Admittance to JCRS, 1909 February 15
Application for admittance to JCRS filled out by hand in ink for Ben Belovsky. Information on the form includes his name, age, birthplace, occupation, residence, marital status, children's ages, nearest relatives, and signed in Yiddish by Ben Belovsky. Nearest relatives listed as Annie Nissman and Jennie Belovsky. At the bottom of the page, under "Recommendation," are two names and addresses. The recommendations were provided in Denver on the 17th of February 1909 and read "Emanuel Friedman, 2760 W. Colfax Ave" and "Louis Schapiro, 2709 W. Colfax Ave." The back of the form has section entitled "Report of Medical Examiner," which states the exam took place on February 17 and the examiner found the patient suffering from stage two tuberculosis. Examiner notes are largely illegible and read "diffuse [illegible] both lungs. newly free of [illegible]. extremely bad" and is signed by Emanuel Friedman. The middle section of the back is a form filled out by hand in ink. It reads "Application No.1032, Case No.702, Application of Ben Belovsky, Address 804 Newton St., Received Feb 15 1909, Accepted Mar 5 1909, Admitted Mar 5 1909, Died February 4 1910." The bottom of the page reads "Admission and Dismission Committee" which reads "applicant very ill. Wife has to take in washing for support. Have been unable to do so for the last two weeks on account of husband being so very ill. Has a baby two weeks old."
- 1909 February 15
- Jewish Consumptives' Relief Society (U.S.) (Producer, Organization)
Language of Materials
Materials mostly in English with a few lines in Yiddish.
Conditions Governing Use
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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
On the front of the application, above the "Recommendation" section to the left side is a note that reads "This app was signed by his wife." Application is torn on both the left and right sides at the middle.
Title supplied by archivist.