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David Gordon's Application for Admittance to JCRS, 1909 March 18

Identifier: B002.01.0101.0034.00001


Application for admittance to JCRS filled out by hand in ink for David Gordon. Information on the form includes his age, place of birth, occupation, residence, marital status, children's ages, previous stays at hospitals, nearest relatives, and is signed by David Gordon. 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 the Medical Examiner," which states the exam took place March 20, 1909 and found the patient to be suffering from stage two tuberculosis. Physician remarks are illegible but section is signed Emanuel Friedman. The middle section of the back is a form filled out by hand in ink. It reads "Application No. 1056, Case No. 727, Application of David Gordon, Address c/o H. Schmit 2737 W 13 ave, Received Mar 18 1909, Accepted Apr 16 1909, Admitted Apr 19 1909, Died Aug 10 1909." The bottom of the page reads "Admission and Dismission Committee" which is blank.


  • 1909 March 18


Conditions Governing Use

Copyright not evaluated: The copyright and related rights status of this Item has not been evaluated. Please refer to the organization that has made the Item available for more information. 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. See:


1 Items (letter)

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.


Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

2150 East Evans Avenue
Denver CO 80208
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