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Isaac Smith's Application for Admittance to JCRS, 1910 August 1-1911 January 18

Identifier: B002.01.0103.0023.00001


Application for admission to JCRS filled out by hand in ink for Isaac Smith. Information on the form includes his age, birth place, occupation, residence, marital status, previous hospital stays, nearest relatives, and is signed in black ink. Signature reads "Isaac Smith (illegible)... cannot write English or Yiddish." 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 August 5, 1910 and found Isaac Smith suffered from Stage II tuberculosis. Under, "Remarks" are notes written in black ink that read "Temperature 102 Pulse 100 [illegible] 38. He claims he visited Dr. Krohn other day for examination but that Dr. K. is [illegible]." Examination notes signed by C.D. Spivak. The middle section of the back is a form filled out by hand in ink. It reads "Application No.1532, Case No.1048, Application of Isaac Smith, Address 1471 Knox Court, Received August 1 1910, Admitted August 5 1910, Died January 18/11." The bottom of the page has a section titled "Admission and Dismission Committee" which is blank.


  • 1910 August 1-1911 January 18


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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

On the back of the form, at the top of the middle section "EMERGENCY" is stamped in red ink.


Title supplied by archivist.

Repository Details

Part of the Special Collections and Archives Repository

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Denver CO 80208
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