Harry Shapiro's Second Application for Admittance to JCRS, 1909 February 23
Second application for admittance to JCRS filled out by hand in ink for Harry Shapiro. Information on the form includes his age, place of birth, occupation, residence, marital status, previous sanatorium stay information, nearest relatives, and is signed in black ink by Harry Shapiro. At the bottom of the page, under "Recommendation," are two names and addresess. The first name and address are illegible. The second reads "Henry Cohen, 625 [illegible] Bldg., Denver, Colo." The back of the form has section entitled "Report of Medical Examiner," which is left blank. The middle section of the back is a form filled out by hand in ink. It reads "Application No. 1036, Case No. 731, Application of Harry Shapiro, Address 1471 Knox Court, Received Feb 23 1909, Apr 20 1909, Apr 21 1909, Died Sept 23 1909."The bottom of the page reads "Admission and Dismission Committee" which is blank.
- 1909 February 23
- 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
On the back of the application, at the top and bottom of the middle form "EMERGENCY" is stamped in blue ink.
Title supplied by archivist.