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David Gottdank's Application for Admittance to JCRS, 1909 April 26

 Item
Identifier: B002.01.0101.0050.00001

Overview

Application for admittance to JCRS filled out by hand in ink for David Gottdank. Information on the form includes his age, place of birth, occupation, residence, marital status, children's ages, previous hospital stays, membership to beneficial societies or lodges, nearest relatives, and signed by David Gottdank. At the bottom of the page is a section entitled "Recommendation" which is left blank. The back of the form has section entitled "Report of Medical Examiner," which states that the examination took place on April 26, 1909 and found the patient to be suffering from stage two tuberculosis. Remarks read "at 3pm no fever, claims has feverand chill latter part of afternoon" and signed by Emanuel Friedman. The middle section of the back is a form filled out by hand in ink. It reads "Application No. 1090, Case No. 754, Application of David Gottdank, Address 1460 Boulevard [illegible], Received Apr 26 1909, Accepted May 11 1909, Admitted May 12 1909, Discharged Aug 22 1909." The bottom of the page reads "Admission and Dismission Committee" which is blank.

Dates

  • 1909 April 26

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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