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Rose Zeretzky's Application for Admittance to JCRS, 1910 July 24-1911 September 26

Identifier: B002.01.0103.0019.00001


Application for admittance to JCRS filled out by hand in ink for Rose Zeretzky. Information on the form includes her age, birth place, residence, occupation, marital status, children's ages, and nearest relatives, and is signed by Mrs. R. Zeretzky. At the bottom of the page is a section entitled "Recommendation" which is left blank. The back of the form has section entitled "Report of Medical Examiner," which is left blank. The middle section of the back is a form filled out by hand in ink. It reads "Application No.1525, Case No.1035, Application of Mrs. Rose Zeretzky, Address Denver Colo., Received 7-24-10, Admitted July 24, 10, Died Sept 26/1911." The bottom of the page reads "Admission and Dismission Committee" which is blank.


  • 1910 July 24-1911 September 26


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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

At the top of the middle section on the back of the form "EMERGENCY" is stamped in red ink.


Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

2150 East Evans Avenue
Denver CO 80208
(303) 871-3428