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Clara Goldberg's Application for Admittance to JCRS, 1909 March 16

 Item
Identifier: B002.01.0101.0033.00001

Overview

Application for admittance to JCRS filled out by hand in ink for Clara Goldberg. Information on the form includes her age, place of birth, occupation, residence, marital status, children's ages, membership to beneficial logdes or societies, nearest relatives, and is signed by Clara Goldberg. At the bottom of the page is a section entitled "Recommendation" which is left blank. The back of the form has a section entitled "Report of Medical Examiner," which states that the examination took place on March 17, 1909 and informs that patient suffers from stage one tuberculosis. Physician's remarks read "tendency to [illegible], no [illegible]" 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. 1055, Case No. 761, Application of Clara Goldberg, Address 2707 Downing Ave, Received Mar 16 1909, Accepted May 15 1909, Admitted May 21 1909, Discharged June 1 1909." The bottom of the page reads "Admission and Dismission Committee" which is blank.

Dates

  • 1909 March 16

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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