Abe Gutnick's Application for Admittance to JCRS, 1907 January 9

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 "Mrs. [illegible], 1517 Dale Ct." The second reads "Mr. Isaacson, 1513 Larimer St." The back of the form has section entitled "Report of Medical Examiner," which states that the examination took place January 9, 1909. M.R. Smirnow, MD remarks that Mr. Abe Gutman [Abe Gutnick] entered the Sanatorium as an emergency case on January 9 1907 having had a hemorrhage the day before. Section is signed by Smirnow. The middle section of the back is a form filled out by hand in ink. It reads "Application No. 393, Application of Abe Gutnick, Address 1517 Dale Ct., Denver, Colorado, Received January 9 1907, Accepted January 9 1907, Admitted Jan 9 1907, Discharged February 1 1907." At the bottom of the middle section is a remark that reads "Emergency Patient." The bottom of the page reads "Admission and Dismission Committee" which is blank.