Application of Edmund Dienstag to JCRS, 1905 June 23

Item

Identifier: B002.01.0097.0060.00004

Staff Only

Abstract

Application for admittance to JCRS filled out by hand for Edmond Dienstag and dated June 23, 1905. Information on the form includes his age, birth place, occupation, residence, marital status, nearest relatives, and signed Edmond Dienstag. The back of the form has sections titled "Report of Medical Advisory Board," blank, and "Report of Executive Committee," blank. The middle section of the back is a form filled out by hand in ink. It reads, "No. 103, Case #51, Application of Edmond Dienstag, June 23/05, Date of Admission July 10, 1905, Died July 22, 1905." A handwritten note underneath notes, "Died July 22, 1905."

Dates

1905 June 23

Creator

Jewish Consumptives' Relief Society (U.S.) (Recipient, Organization)

Rights and Usage Statement

This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. In addition, no permission is required from the rights-holder(s) for educational uses. For other uses, you need to obtain permission from the rights-holder(s). http://rightsstatements.org/vocab/InC-EDU/1.0/

Extent

1 Items (application)

Additional Description

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

Fair 30 x 22 centimeters

General

reformatted digital

Title supplied by archivist.

Inscription and Marks

Stamped on the front in blue ink, and filled out in blue ink, is the following: "Received: June 23, Accepted July 10 -05, Admitted, ", Discharged, Left, Died 7-22-05."