Reuben Goldberg's Application for Admittance to JCRS, 1906 July 6

Item

Identifier: B002.01.0097.0174.00001

Staff Only

Abstract

Application for admittance to JCRS filled out by hand in ink for Reuben Goldberg. Information on the form includes his age, place of birth, occupation, residence, marital status, nearest relatives, and is signed by Reuben Goldberg. A stamp in blue ink informs the following: "Received Jul 6, 1906, Accepted Jul 23 1906, Admitted July 23 1906." The back of the form has section entitled "Report of Medical Examiner," which is left blank. the middle section of the back if a form filled out by hand in ink. It reads "No. 261, Application of Reuben Goldberg, Date of Admission June 27 1906, Date of Discharge December 9 1906."

Dates

1906 July 6

Creator

Jewish Consumptives' Relief Society (U.S.) (Producer, Organization)

Conditions Governing Use

This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). http://rightsstatements.org/vocab/InC-EDU/1.0/

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.

Physical Characteristics and Technical Requirements

On the top of the front of the application, written in black ink is a note that reads "261" and is underlined. On the back of the form, in the top of the middle section, is a note written in blue ink that reads "Case #160, EMERGENCY" which is underlined. Below that in the row titled "Date of admission" the date July 23 is crossed out and "June 27" is written.