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Bertha Jacobs' Application for Admittance to JCRS, 1909 November 22

 Item
Identifier: B002.01.0102.0028.00001

Overview

Application for admission to JCRS filled out by hand in ink for (mrs) Bertha Jacobs. Information on the form includes his age, birth place, occupation, residence, marital status, children's ages, and nearest relatives. Form is signed "Bertha Jacobs 1460 Lowell Blvd." Nearest relative is listed as "Husband David Jacobs, Boyers, Pa." The Recommendation section at the bottom of the page is blank. The section "Report of the Medical Examiner" on the back side of the reports that Mrs Jacobs is suffering from stage 2 tuberculosis, states "Medical attached to application" and is signed C.D. Spivak. The middle section of the back of the form reads "Application No. 1281. Case No. 932. Application of Bertha Jacobs. Address 1460 Lowell Blvd. Received Nov 22 1909. Admitted March 3/10. Left Oct 3/10 Aug 2, 1910." The "Admission and Dismission Committee" section of the back of the form is left blank.

Dates

  • 1909 November 22

Creator

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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.

General

Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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