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Hyman Gumple's Application for Admittance to JCRS, 1910 July 11-1910 August 6

 Item
Identifier: B002.01.0103.0011.00001

Overview

Application for admission to JCRS filled out by hand in ink for Hyman Gumple. Information on the form includes his age, birth place, occupation, residence, previous residence, marital status, previous hospital stays, nearest relatives, and signed by Hyman Gumple. At the bottom of the page, the section "Recommendation," is left blank. The back of the form has section entitled "Report of Medical Examiner," which states that the examination took place July 12th, 1910, found Hyman Gumple suffered from advanced tuberculosis, and is signed by M.J. Krohn. The middle section of the back is a form filled out by hand in ink. It reads "Application No.1511, Case No.1037, Application of Hyman Gumple, Address 12221 Larimer St. Denver Colo., Received July 11 1910, Admitted July 25 1910, Died Aug 6 1910." The bottom of the page has a section titled "Admission and Dismission Committee" which is blank.

Dates

  • 1910 July 11-1910 August 6

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

Next to the section "Recommendation" is a handwritten note in ink that reads "Letter from H. Masliansky."

General

Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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