Abe Gutnick's Third Application for Admittance to JCRS, 1909 April 14

Item

Identifier: B002.01.0101.0044.00001

Staff Only

Overview

Third application for admittance to JCRS filled out by hand in ink for Abe Gutnick. Information on the form includes his age, place of birth, occupation, residence, marital status, previous hospital stays, nearest relatives, and signed by Abe Gutnick. At the bottom of the page, under "Recommendation," are two names and addresses. The first reads "M. Leaphine, Address 917 15th st." The second reads "M. Ginsborg, Address 1437 [illegible]." The back of the form has section entitled "Report of Medical Examiner," which states the exam took place on April 14, 1909 and informs that the patient suffers from stage three pulmonary tuberculosis. Medical examiner notes that Abe Gutnick had no fever at the time of exam at 2:30pm and section is signed by Emanuel Friedman. The middle section of the back is a form filled out by hand in ink. It reads "Application No. 1078, Case No. 737, Application of Abe Gutnick, Address 1476 Irving St, Received Apr 14 1909, Accepted Apr 20 1909, Admitted Apr 22 1909, Discharged February 17 1910." The bottom of the page reads "Admission and Dismission Committee" which is blank.

Dates

1909 April 14

Creator

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

Conditions Governing Use

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

Black ink spilled on the back of the application towards the bottom right corner. On the front of the application under the date "2nd" is written before the word "Application." On the back of the form in the middle section at the top "3rd Application" is written in black ink.