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Alex Shifman's Application for Admittance to JCRS, 1909 May 28

Identifier: B002.01.0101.0069.00001


Application for admission to JCRS filled out by hand in ink for Alex Shifman. Information on the form includes his age, birth place, occupation, residence, marital status, nearest relatives, and signed by A. Shifman. At the bottom of the page, under the section "Recommendation," are two names and addresses. The first reads "Louis Shapiro, 2709 W Colfax ave" and the second reads "Nathan Wiener, 2626 W Colfax ave." The back of the form has section entitled "Report of Medical Examiner," which states that the examination took place May 31, 1909 and found Mr. Ginsburg suffered from Stage II tuberculosis. Under, "Remarks" is a note that reads "Rt lung especially involved, lost 25 lbs, voice hoarse for the past 9 weeks, night sweats up to a year ago" and is signed in black ink by Robert L. Charles, MD. The middle section of the back is a form filled out by hand in ink. It reads "Application No. 1124, Case No. 786. Application of Alex Shifman, Address 1466 Irving St. Received May 28, 1909, Accepted June 21, 1909, Admitted June 29, 1909, Died Oct 31, 1909." Below that, a note reads "take in next" and is signed by "Disraelly." The bottom of the page has a section titled "Admission and Dismission Committee" which is blank.


  • 1909 May 28


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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

On the back of the application, at the top of the middle section, "EMERGENCY" is stamped in blue ink.


Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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