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Catherine Queen's Application for Admittance to JCRS, 1909 May 10

 Item
Identifier: B002.01.0101.0059.00002

Overview

Application for admittance to JCRS filled out by hand in ink for Catherine Queen. Information on the form includes her age, place of birth, occupation, residence, marital status, previous hospital stays, nearest relatives, and signed by Catherine Queen. At the bottom of the page, under "Recommendation," are two names and addresses. The first reads "Barney [illegible], 1459 Knox Ct," and the second reads "Leon Mussoff, N 1569 Julian St." The back of the form has section entitled "Report of Medical Examiner," which states that the examination took place May 13, 1909 and is signed by Robert L. Charles, MD. Report informs that the case is "well advanced, lost 25 lbs - past two years, has had very severe pulmonary hemorrhage four months ago, has [illegible] which was operated upon in Co. Hosp. few months ago." The middle section of the back is a form filled out by hand in ink. It reads "Application No. 2006, Case No. 790, 2nd Application of Catherine Queen, Address 1459 Knox Court, Received May 10 1909, Accepted May 12 1909, Admitted July 5 1909, Discharged Dec 5/10." The bottom of the page reads "Admission and Dismission Committee" which is blank.

Dates

  • 1909 May 10

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.

Physical Characteristics and Technical Requirements

Two pieces of tape are present on the front of the application. On the back of the form, under the "Report of Medical Examiner" the phrase "while in Co. Hospital" is crossed out in black ink. On the back of the form in the middle section, where "Application No. 2006" is, "1106" is stamped in black ink.

General

Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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