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Carrie Kokush's Application for Admittance to JCRS, 1909 November 5

 Item
Identifier: B002.01.0102.0021.00001

Overview

Application for admission to JCRS filled out by hand in ink for Carrie Kokush. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, and nearest relatives. Form is signed "Carrie H Kokush." Nearest relative is listed as "a Hruschka, 319 Washingtton st. Father." In the Recommendation section at the bottom of the page is left blank. The section "Report of the Medical Examiner" on the back side of the form states examination took place on November 5th, 1909, found that Mrs. Kokush suffered from stage 3 tuberculosis and is signed "C.D.Spivak." The middle section of the back of the form reads "Application No. 1273. Case No. 876. 2nd Application of Carrie KoKush. Address 1389 Oscoala. Received Nov 5, 1909. Admitted Nov 24 1909. Died September 11/10." The "Admission and Dismission Committee" section of the back of the form is left blank.

Dates

  • 1909 November 5

Creator

Language of Materials

From the Collection: The records are primarily in English, but some materials are in other languages, including Hebrew, Yiddish, German, and Russian.

Conditions Governing Use

Copyright restrictions may apply. User is responsible for all copyright compliance.

Extent

1 items

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

In the middle section of the back, 2nd in pencil before "application of" and "Emergency" is stamped in red directly under it.

General

Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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