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Ethel Tuberman's Application for Admittance to JCRS, 1909 October 18

 Item
Identifier: B002.01.0102.0008.00001

Abstract

Application for admittance to JCRS filled out by hand in ink for Ethel Tuberman. Information on the form includes her age, birth place, occupation, residence, marital status, and nearest relatives, and is signed by Ethel Tuberman. Beside the signature is a note that reads "Will bring address as soon as she moves N.J.H." At the bottom of the page, under "Recommendation" there is a note that reads "Letter from J. Previant, Mr H. Goldstein of Ft. Wayne". The back of the form has section entitled "Report of Medical Examiner," filled out by hand in ink and signed by S.S. N. Drohn and states that the examination took place October 20, 1909, diagnosis of stage II tuberculosis with no remarks. The middle section of the back is a form filled out by hand in ink. It reads "Application No.1250. Case No.868, Application of of Ethel Tuberman, Address Nat Jew Hospital, E. Colfax and Jackson, Admitted Nov 12 1909, Discharged July 5 1910. There is a section at the bottom of the back of the page titled "Admission and Dismission Committee" which is left blank.

Dates

  • 1909 October 18

Creator

Conditions Governing Use

This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). http://rightsstatements.org/vocab/InC-EDU/1.0/

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

"1237 Bannock" is added in pencil to the address line under signature on the front side of the application and to the address line in the form on the middle section of the back side of the application.

General

Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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